Detroit Free Press - Republican Repeal Efforts Show ACA Benefits

Op-Ed

By Sander Levin

The aftermath of last Friday's derailment of the Republican effort to repeal the Affordable Care Act is clear. The GOP bill ended up showing the many strengths of the ACA.

Over 20 million Americans are covered -- roughly half through expanded Medicaid and half through the insurance plans provided through the marketplaces. Even more could be covered if additional states took advantage of the Medicaid expansion, which some are now beginning to do.

In Michigan, the uninsured rate has been cut by more than half since 2010 -- from 12.4% to 6.1% -- with nearly one million Michiganders now receiving coverage thanks to the state's expanded Medicaid program and the ACA marketplace.

In short, the ACA is not imploding. As President Barack Obama left office, signups were at record levels for that time of year, and the nonpartisan Congressional Budget Office recently found that recent ups and downs in the individual marketplace would stabilize.

But there are both threats and short-term challenges. The major threat is that the Trump administration will fail to fully implement and enforce the law -- destabilizing coverage and increasing costs for millions of Americans.

As for the other challenges the law may face, the administration and the U.S. Congress can easily work together to meet them if Republicans move beyond their single-minded efforts to repeal and undermine the law.

The most pressing issue before us is the Republican effort to block the ACA's cost-sharing reductions program, which lower out-of-pocket medical expenses for moderate-income Americans. While many Americans may not be aware that they benefit from this provision, the cost-sharing subsides are crucial to keeping costs down for consumers, including more than 160,000 in Michigan.

But House Republicans are currently suing to prevent the administration from providing this assistance, and the administration and U.S. Speaker of the House Paul Ryan, Republican of Wisconsin, have not stated how they will proceed. Without this program, as Republican U.S. Rep. Tom Cole of Oklahoma said at a congressional hearing this week, we will see "insurance companies exiting the market."

In addition, the administration must fulfill its duty to enforce the individual mandate. If the mandate is eliminated, premiums will skyrocket and many insurers will no longer offer plans, leading to a death spiral that could destroy the individual market.

The administration's responsibility on this issue is clear -- it must enforce the law. As U.S. Secretary of Health and Human Services Tom Price said this week, "So long as the law is on the books, we at the department are obliged to uphold the law."

Republicans must also reverse course and support risk mitigation measures, such as the ACA's risk corridors program. Republicans have cut funding and sabotaged the Obama administration's efforts to help insurers deal with uncertainty during the early days of the ACA. Their actions have directly contributed to higher premiums and have harmed stability in the individual market in some areas.

The time has come to move beyond these harmful efforts and provide funding to help reduce premiums and stabilize the insurance market.

Finally, there are other simple steps the administration must take to make it easier -- not harder -- to sign up for coverage. Instead of shortening the open enrollment period, as the Trump administration has proposed, Americans should have a longer window to enroll in coverage. And during the next open enrollment period, the administration should support funding for advertising that encourages young people to sign up.

As the dust settles on the failed repeal effort, Republicans must take stock of what happened. The public spontaneously spoke up and rejected their ideas. At rallies and town halls in our districts, we heard unforgettable stories about how the ACA was helping millions of Americans. Major organizations such as the American Hospital Association, the American Medical Association, and the AARP told us of the devastating consequences of repeal.

Republicans must recognize that the question today for America's health is not how to repeal, but is how to heal.

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