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A Bipartisan Path Forward


It is time for Congress to put the past seven years and seven months of partisan bickering over the Affordable Care Act (ACA) behind us. It is time to come together, on a bipartisan basis, and work to improve our nation’s health care system. For the first time in a long time, I am hopeful thatthis can be achieved.

Thanks to the ACA, more than 20 million previously uninsured Americans—including one million Illinoisans—have gained the security of health insurance coverage. Individuals with pre-existing conditions can no longer be discriminated against. Millions more are now able to access mental health and substance abuse treatment. Young people can stay on their parents’ health plans longer and seniors are benefiting from deep discounts on their prescription drugs. We cannot turn our backs on this progress.

However, despite all the positive gains from the ACA, this law is not perfect. Approximately 6% of Americans—3% of Illinoisans—purchase their insurance in the individual market. For too many of these people, premiums are unaffordable, insurance options are limited, and provider networks are overly restrictive. All of these challenges make it difficult for hospitals, providers, and community clinics to do what they do best. Improvements can, and should, be made.

In the wake of failed congressional Republican efforts to repeal the ACA, bipartisan leaders of the Senate Health, Education, Labor, and Pensions (HELP) Committee have convened a series of important and long-overdue hearings to discuss ways to strengthen the individual insurance market. They have brought in Republican and Democratic Governors and Insurance Commissioners, a former Secretary of the Department of Health and Human Services (HHS), health insurance executives, health system CEOs, providers, and patients. When crafting the ACA in 2009 and 2010, the Senate held over 50 bipartisan hearings to hear from experts, solicit input and recommendations, educate the public, and receive feedback—all of which is essential when considering a bill that affects one-sixth of the American economy.

To the surprise of many, there has been broad consensus from these experts about the steps Congress should take to shore up and help stabilize the individual market.

Fund the Cost-Sharing Reduction Subsidies Now

These witnesses—Republican and Democrat—explicitly recommend that the HHS continue funding the cost-sharing reduction subsidies, which help seven million Americans afford their health care co-payments and deductibles. Unfortunately, the Trump Administration has repeatedly threat ened to stop making these payments, stoking widespread uncertainty in the health insurance industry. As a result, average health insurance premiums are slated to increase 20% next year alone.

“To the surprise of many, there has been broad consensus from these experts about the steps Congress should take to shore up and help stabilize the individual market.”

Reinsurance Options

These witnesses recommend that Congress establish a new funding stream to help states cover higher-cost patients. A small number of patients with expensive medical needs can drive up health insurance costs for all. If we could help reimburse states for higher-cost patients, we could drive down costs for others. We do this in the Medicare program, and a handful of states have adopted this approach for their individual markets—I believe this should be undertaken nationwide.

Individual Mandate

These witnesses have largely argued in favor of the individual mandate or some other mechanism—such as auto-enrollment into a health plan—to ensure that young and healthy individuals obtain insurance. It is no secret that the individual mandate has been unpopular in some circles, but it plays an important role in keeping premiums low. Unfortunately—by issuing an Executive Order on day one of his presidency, instructing federal agencies not to enforce the mandate—President Trump has significantly undermined the individual mandate’s goal of lowering premiums.

State Flexibility While Protecting Essential Health Benefits

Many of these witnesses have made the case for greater state flexibility with respect to the law. While I would strongly oppose any effort that allows states to waive important consumer protections currently in place, under the guise of “patient choice”—such as protections for people with pre-existing conditions—I think there is room for further discussion on this subject. Governor Rauner has thus far declined to provide any input regarding what flexibility Illinois might need, despite my repeated requests that he do so.

Public Option and Prescription Drug Costs

The recommendations above represent an incomplete list of ideas that enjoy some amount of bipartisan support, but there are other proposals deserving of serious consideration—such as the creation of a public, not-for-profit health insurance option to compete alongside private insurance companies. I also believe it is long past time that Congress act to address one of the true cost drivers in health care spending: skyrocketing prices for prescription drugs.

But it is my hope—and I believe the hope of the American public—that we have seen the last of partisan efforts to repeal our health law and slash federal Medicaid funding. It is my hope that Congress will finally move forward on a bipartisan basis to pass a bill that includes some of these common-sense proposals. If we did, there is no doubt in my mind that we would make a positive impact on the lives of many Americans.

Richard J. Durbin is the senior U.S. Senator representing Illinois.

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