by Mitch Kokai
Senior Political Analyst, John Locke Foundation
Even if Republicans had succeeded in their recent efforts, skinny repeal would have come nowhere close to solving the problems that plague our health-care system, especially rising costs and declining choices. Of course, the ACA also failed to solve those problems and in many ways exacerbated them. Republicans — hopefully working with Democrats — should not give up on reform that would lower costs, improve quality and ensure more widespread adoption of exciting health-care innovations. The recent failed effort highlights what some of these reforms might be.
On the legislative front, there are several rifle-shot provisions that could be attached to must-pass pieces of legislation, such as continued funding for the Children’s Health Insurance Program. The Congressional Budget Office estimates that medical liability reform could save almost $50 billion over 10 years. And allowing the purchase of insurance across state lines would help expand insurance markets, consequently, improving options for consumers in states burdened by heavy insurance mandates. Republicans could also eliminate the Independent Payment Advisory Board, a government body that has drawn bipartisan criticism for the extraordinary power it has to make significant cuts to the Medicare program.
Beyond legislation, the Trump administration can improve the ACA through the regulatory process. As Health and Human Services Secretary Tom Price has said: “There are 1,442 citations in the Affordable Care Act where it says, ‘The Secretary shall .?.?.’ or ‘The Secretary may .?.?.'” That gives the administration significant flexibility to shape the law how it chooses. Price should use that authority to promote choice in insurance marketplaces, enhance innovations in state Medicaid programs and advance policies that help to lower premiums for more Americans.
On the Medicaid front, Republicans typically put a lot of faith in state innovation and the ability of federal authorities to work with governors to expand coverage and lower costs. Now, it is up to federal officials to make sure that these experiments lead to results. That means working with both Republican and Democratic governors to address continuing challenges around coverage and, more important, fiscal sustainability.