Health Care: The Bad, the Good, and the Enduring Values

The health care roller coaster continues.

Last week, the Trump Administration announced two potentially major decisions on health care: the first was an executive order recommended making it easier to sell association health plans and short-term insurance not subject to the Affordable Care Act’s (ACA) consumer protections; the second was the announcement that the administration would no longer fund Cost Sharing Reductions (CSRs). Insurance providers receive CSRs as reimbursements for the lower out-of-pocket costs they are required to offer to certain consumers.  

This past Tuesday, Senators Lamar Alexander (R-Tennessee) and Patty Murray (D-Washington) announced a bipartisan agreement to stabilize the individual market. Meanwhile, Congress has yet to reauthorize funding for the Children’s Health Insurance Program (CHIP), despite bipartisan support for the program and a deadline that passed almost three weeks ago.

This blog will explore each of these issues--and more--and provide the latest information about the future of health care.

The Bad: CHIP and Administrative Sabotage

The “Murray-Alexander” agreement is exciting, but should not distract from the need to reauthorize funding for CHIP. Congress missed the official September 30 deadline to reauthorize program, leaving some states with less than two months until they have no money to fund children’s health care. States may begin to notify families of coverage loss as early as November 1 if Congress does not reauthorize funding. As I have previously written, CHIP provides essential services for nine million children, providing kids with the medical care they need and families with the assurance they deserve.

The Trump Administration’s actions last week are just the latest of many that are directly undermining the ACA. Ending CSRs would cause serious damage to the individual market, adding to potential chaos wrought by the enormous cuts to enrollment advertising and assistance funding announced at the end of August. Enrollment advertising and assistance is critical for attracting consumers into the marketplace, particularly younger and healthier enrollees who help drive down costs.  Each of these issues would be addressed by Alexander-Murray proposal.

On the other hand, the President’s executive order is a threat not addressed by the bipartisan deal. The executive order recommends that the Departments of Treasury, Labor, and Health and Human Services offer new regulatory interpretations to allow the purchase of association health plans not subject to the ACA’s crucial protections—such as those for people with preexisting conditions. The executive order also recommends extending the maximum length of short-term insurance from three months to a year. The impact of the proposals would be the same: to create a separate and unregulated risk pool from the ACA’s marketplaces. This could have devastating impacts on those who continue to utilize the non-group marketplaces, and would offer few protections for people with association health plans (an insurance option that has a spotty history at best).

The Good: Bipartisanship in the Senate

Since the collapse of the Better Care Reconciliation Act (one of the recent attempts to repeal the ACA) in July, Senators Alexander and Murray have led discussions about policies that could lower costs and inject much-needed certainty into the ACA’s marketplaces. With President Trump’s decision on CSRs, a Congressional solution became urgent.

The contours of the agreement suggest that it would do substantial good for the ACA’s marketplace. The deal includes a two-year authorization of the CSRs, which will offer certainty for insurers that rely on the payments and lower costs for consumers. The deal would also restore funding for open enrollment advertising that was cut by the Trump Administration, ease states’ abilities to innovate their marketplaces, and allow people over the age of 30 to purchase “catastrophic coverage.” These solutions are not comprehensive fixes to the health care system, but are common-sense approaches that should help millions.  

More important than the particular policies recommended in the plan is the fact that members of both parties are cooperating in good faith on health care. Skin in the game from each party could help reduce the political gamesmanship that has plagued health care policy since the ACA’s passage.

Enduring Values

With so much happening on this topic, it is important to stay grounded by the values that inform our perspective on the issue. The Shulchan Aruch, the seminal 16^th century Jewish legal text, directly addresses the need to provide healing for all those in need. Doctors who withhold treatment from those who need it are considered to have shed blood (Yoreh De’ah 336:3). Today’s health care system encompasses a wide range of groups—doctors, nurses, insurance providers, hospital administrations, as well as lawmakers. Lawmakers who reduce access to medical treatment bear the same responsibility as doctors who do not help those in need.

Urge your member of Congress to support reauthorizing the Children’s Health Insurance Program.

For the latest updates on health care, visit the RAC’s health care page.