So here we are again. As in May and July, Congress has once again hit an embarrassing setback in its latest bid to repeal major tenets of the Affordable Care Act.
Regardless of your thoughts on the substance of the repeal efforts, suffice it to say the closed-door, partisan process has not exactly been a model of how legislation affecting the lives of tens of millions of Americans should be carried out.
On the other hand, maintaining the ACA's broken status quo is still not a viable alternative. While a nonpartisan Congressional Budget Office report issued earlier this month confirmed that insurance rates will rise due to "short-term market uncertainty" under the current Congress and administration, we also know that, before President Trump came to power, rates were already set to spike by an average of 25 percent across the country for 2017.
More than seven years after this flawed law was foisted on the American people on a party line vote, and on the heels of another botched repeal effort carried out the same way – it's time for Congress to try something new: governing by consensus to solve health cost challenges in a meaningful way, even it means taking smaller steps for now, with the hope of larger gains down the road.
The Congressional Problem Solvers Caucus, a bipartisan slate of Governors led by John Kasich, R-Ohio, and John Hickenlooper, D-Colo., and other Capitol Hill thought leaders have identified the healthcare law's state waiver program, formally known as Section 1332, as one area that is ripe for bipartisan reform.
Section 1332 of the ACA enables states to waive certain elements of the healthcare law – benefit requirements, enrollment periods, tax credits – if the state approves reforms that meets the same benchmarks.
Democrats like that changes to the 1332 program don't amount to "repeal" – after all, we're talking about an existing provision of the ACA put into law by President Obama and Democrats in Congress – and Republicans like that reforms to the program offer an avenue to give states more autonomy over their healthcare decisions.
The problem with 1332 waivers today? The process to get a waiver approved is long and difficult. Of the 23 states that have taken steps to start the process so far, only two have succeeded.
The arduous application process and narrow interpretation of the law created by the Obama Administration made it all but impossible for meaningful flexibility, stifling the very innovation the law pretends to support. The ACA encourages state-based solutions on paper, but not in practice.
Don't take my word for it. Just last week, Minnesota Governor Mark Dayton, a Democrat, blasted the waiver process as "nightmarish."
Regardless of party affiliations, Governors and states deserve the leeway from Washington to enact reforms that meet the unique needs of their population, not just lip service.
The Council for Affordable Health Coverage, where I serve as President, is leading the charges on reforms to make the 1332 reward state innovation instead of stifling it.
To start, we propose condensing the federal government's 180-day timeline to review state applications down to 90 – three months is plenty to give a simple yes or no.
Additionally, we are calling for Congress to remove the requirement that state legislatures first codify their waiver application as a state law. This is particularly burdensome for legislatures with biennial schedules and does a disservice to taxpayers.
Why force a state to expend the time, energy, and cost on an item of legislation before transmitting it to Washington for approval – creating the possibility that your elected officials could spend months deliberating on a bill only to see it voided at the hands of unelected bureaucrats in Washington. Before Alaska's waiver was approved, the state had to amend their law three times.
Next, Congress should ease the stringent guardrails used to accept or reject state proposals. Today, for example, if a state submits a waiver application for a program that will improve affordability, insure more people, and offer equally comprehensive options but it adds to the deficit in the first year – that plan faces immediate rejection, even if the costs balance over time.
This is nonsense. If a state demonstrates its plan can improve markets for consumers, it should be an easy call for federal officials – their rigid checklists notwithstanding. That is why we are calling on the Trump administration to issue a new enforcement rule that creates more flexibility for states in waiver review and approval.
Finally, flexibility is all good and well, but it doesn't mean much if states lack the funds to get their efforts off the ground. For this reason, we believe any health reform bill taken up in Congress must include a grant program to incentivize 1332-based reforms, which can work to stabilize markets and protect consumer access in the absence of Congressional action.
When it comes to healthcare decisions, one size doesn't fit all. Badgers, Buckeyes, Hawkeyes, and Hoosiers all have unique constituencies with unique healthcare needs. These states have the tools and the know-how to care for their people – they just need the freedom to do it.
Joel White is the president of the Council for Affordable Health Coverage. Learn more at CAHC.net
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