Ten House Democrats unveil plan to stabilize & improve the individual marketplace

Less than one week after Senator Majority Leader Mitch McConnell (R-KY) stated that a limited bill could be needed to stabilize the health insurance marketplace, a group of House Democrats from across the political spectrum unveiled a five-part plan to improve upon the Affordable Care Act and stabilize the individual marketplace.

The plan, titled Solutions over Politics, seeks to stabilize the individual market while protecting plans for people with pre-existing conditions, keeping costs down for lower income folks, promoting enrollment and ensuring everyone pays their fair share. The plan also calls for improvements to the ACA including ways to reduce churn in the market and drawing bidding areas to ensure that rural areas aren’t left at a disadvantage.

Led by the New Democrat Coalition Co-Chairs of the Affordable and Accessible Health Care Task Force, Reps. Kurt Schrader (OR-05), Ami Bera, M.D. (CA-07) and Ann McLane Kuster (NH-02), the group is comprised of members from across the country representing diverse parts of the Democratic Caucus, including members of the House Energy and Commerce and the House Ways and Means Committees, through which the Affordable Care Act was marked up and passed during the 111th Congress.

“It’s time to tackle the real issues. The Affordable Care Act has helped 20 million people access quality health care, many for the first time in their lives,” said Rep. Schrader. “Medicaid expansion has been an unqualified success in red and blue states. But we have to face facts: some folks in the individual marketplace have seen their premiums and deductibles increase significantly due to an imbalance in the marketplace and uncertainty caused by this new administration. Let’s fix that! Our five-point proposal aims squarely at stabilizing and improving the individual market. We’ve talked with health care experts, providers, and patients to find real solutions. If we are serious about making health care affordable for everyone, let’s direct our focus there.”

“We know that the Affordable Care Act has challenges that need to be addressed to expand access to health insurance and bring down costs, but the Republican proposal is not the right answer,” said Rep. Kuster. “Under the GOP’s plan, thousands of people in New Hampshire and millions of Americans, including millions of veterans, could lose access to health care. Today we’re announcing priorities for what I hope will be the first steps toward bringing together Republicans and Democrats behind commonsense proposals to improve the Affordable Care Act for all Americans.”

“As a doctor, health care is about putting the patient’s health first, reducing costs, and increasing the number of people insured – and that’s exactly what these proposals do,” said Rep. Bera. “We’ve made great progress under the Affordable Care Act and it’s time to stop playing politics with people’s lives. I’m urging Democrats and Republicans to work across the aisle and implement these bipartisan ideas that will improve our health care system.”

The group also includes Reps. Peter Welch (VT-At Large), Scott Peters (CA-52), Terri Sewell (AL-07), Kathleen Rice (NY-04), Jim Himes (CT-04), Ron Kind (WI-03), and Suzan DelBene (WA-01).

The plan follows:


Protect Plans for People with Pre-Existing Conditions

What’s Working: The “guaranteed issue” and “community rating” provisions of the ACA ensure patients can’t be denied coverage or charged more based on pre-existing conditions.

What’s the Problem: Many Americans in the individual market have experienced hikes to their premiums and deductibles because some patients have required more health services than their plan predicted. Without a sufficiently funded reinsurance program, insurers will charge higher premiums to make up for, or in anticipation of, financial losses.

What’s our Solution: Create a dedicated annual $15 billion reinsurance fund.

Keep Costs Down for Lower Income Families

What’s Working: The ACA helps millions of families purchase affordable health coverage through cost sharing reduction (CSR) payments. These funds reduce copays and deductibles for lower income families across the country.

What’s the Problem: Uncertainty about funding CSR payments is already creating a crisis in the market, leading to fewer choices for consumers and driving up premiums. These premium increases could cause federal spending to increase by $2.3 billion next year alone.

What’s our Solution: To avoid calamity for millions of Americans, Congress must make it clear that these payments will continue now and into the future.

Promote Enrollment and Ensure People Pay their Fair Share

What’s Working: There’s a correlation between states with more visible marketing strategies around open enrollment periods and the number of people who enroll.

What’s the Problem: We need to ensure people, particularly healthy people, enroll in coverage and stay enrolled. The Administration’s removal of marketing materials in January caused decreased enrollment, and wavering statements around enforcement of the shared responsibility requirement have caused uncertainty among insurers.

What’s our Solution: Robust marketing strategies across the country, particularly during open enrollment periods, would expand the risk pool by bringing younger, healthier adults into the marketplace. We must also continue to enforce the individual shared responsibility requirement of the ACA.


Creating More Affordable Options

Create more options for Americans near Medicare eligibility, including the ability to buy in to Medicare or Medicare Advantage.

Provide additional targeted premium support by age and geography as well as income.

Expand the availability of catastrophic health insurance plans that include essential health benefits and coverage for primary care for younger enrollees.

Ensure that health savings accounts (HSAs) are flexible and compatible with plans compliant with the ACA.

Technical Changes and Improvements

For Enrollment: Consider aligning the ACA’s open enrollment period with tax season.

For Rural America: Ensure rural areas are not at a disadvantage by drawing bidding areas in the individual marketplace to include a balanced pool of enrollees.

For Efficiency: Consider ways to boost and expand use of the Basic Health Program to streamline coverage between Medicaid and the individual private insurance market. Consider allowing ACA subsidy certification for multiple years, which would give people and plans certainty for longer periods.

For Innovation: Spur innovation and bring more choice and competition to the market by issuing clear guidelines and working with states to incorporate smart waiver opportunities that increase choice while maintaining strong consumer protections.

Read the white paper here.

Media Contact: Carlee Griffeth, Director of Communications for Congressman Kurt Schrader