{"id":191697,"date":"2017-07-30T02:45:59","date_gmt":"2017-07-30T02:45:59","guid":{"rendered":"http:\/\/healthmedicinet.com\/i\/news-analysis-consensus-is-health-law-can-be-fixed-now-the-hard-part\/"},"modified":"2017-07-30T02:45:59","modified_gmt":"2017-07-30T02:45:59","slug":"news-analysis-consensus-is-health-law-can-be-fixed-now-the-hard-part","status":"publish","type":"post","link":"http:\/\/healthmedicinet.com\/i\/news-analysis-consensus-is-health-law-can-be-fixed-now-the-hard-part\/","title":{"rendered":"News Analysis: Consensus Is Health Law Can Be Fixed. Now the Hard Part."},"content":{"rendered":"

Among the hardest hit are those who do not qualify for subsidies to help with premiums or out-of-pocket costs, which rise along with rate increases. Michael Lawson, an independent consultant for local governments in Washington, D.C., said the monthly premiums for his basic plan from CareFirst jumped to $527 this year from $290 last year. He is 60 and earns too much to get a subsidy, but because of various health problems he has already reached his $5,000 deductible for the year. He likes his plan but thinks that to keep rates more stable, Congress and the Trump administration need to do a better job of enforcing the law, particularly its requirement that most people have health insurance<\/a>.<\/p>\n

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Demonstrators in front of the Supreme Court in Washington in 2015 cheered after its decision to allow nationwide health care subsidies, which affirmed a key element of the health care law.<\/span>
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\n Credit<\/span>
\n Zach Gibson\/The New York Times <\/span>
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\u201cThey need to enforce the A.C.A. as it\u2019s written,\u201d he said. \u201cDon\u2019t kill it by benign or even malicious neglect.\u201d<\/p>\n

The politics are exceedingly tricky in a divided and dysfunctional Washington, but economists, insurers, doctors and health policy experts across the political spectrum agree that immediately addressing three or four basic shortcomings in the existing system would go a long way toward making the law more effective and financially stable.<\/p>\n

Stabilize the Markets<\/h4>\n

There is widespread agreement that the first order of business is to calm very jittery insurance markets. \u201cYou need to stabilize things before we change them,\u201d said Michael Neidorff, the chief executive of Centene, one of the few insurers that are aggressively expanding in the market.<\/p>\n

Time is of the essence: Next month, insurers must decide what they charge for 2018 or whether they want to stay in the marketplaces at all.<\/p>\n

The most significant step would be to guarantee continued funding to reimburse insurers for waiving deductibles and co-payments for low-income customers, as the health law requires companies to do. The Trump administration has threatened to stop making the payments; insurers are now getting them on a month-to-month basis.<\/p>\n

If these so-called cost-sharing reductions are not paid for the remainder of the year or in future years, people will see premiums go up by nearly 20 percent to cover them, according<\/a> to the Kaiser Family Foundation.<\/p>\n

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Companies could also decide to leave the market, creating a potential collapse, said Mike Kreidler, the insurance regulator for Washington State. In a statement issued Friday<\/a>, state regulators urged lawmakers to move quickly. \u201cWe have insurers who are very apprehensive and very nervous,\u201d he said.<\/p>\n

While insurers are hopeful that Congress will pass legislation guaranteeing the payments, they would also welcome a commitment from the administration that it, too, wanted to stabilize the market. \u201cThere seems to be a conflict internally: Are they going to sabotage the market or are they going to help the market?\u201d said Gary Cohen, a former Obama administration official who is now an executive at Blue Shield of California.<\/p>\n

President Trump has hinted he is unwilling to help. His Twitter post<\/a> on Friday reacting to the Senate vote, like others he has posted recently, suggested a willingness to watch the market collapse: \u201cAs I said from the beginning, let ObamaCare implode, then deal.\u201d In another post<\/a> on Saturday, he warned that bailouts \u201cfor insurance companies\u201d could \u201cend very soon.\u201d<\/p>\n

But the fundamental problem that many insurance customers face is sky-high deductibles or premiums that are simply out of reach. Health economists and others say there are ways to lower premiums so more people can afford coverage.<\/p>\n

\u201cOne of the best quick fixes that is not controversial is reinsurance,\u201d said Paul Ginsburg, a health economist who directs the Center for Health Policy at the Brookings Institution. That would involve the government helping insurers pay for the sickest, most expensive people, whose costs can drive up premiums in places where there are not enough healthy customers to balance them out.<\/p>\n

The Affordable Care Act provided the funding for three years, but many people think reinsurance needs to be permanent. A bipartisan agreement seems possible now because in their failed replacement bills, both House and Senate Republicans had supported the idea of providing assistance to insurers, as well as extra \u201cstabilization\u201d funding for states to potentially help lower people\u2019s premiums and deductibles.<\/p>\n

Over the longer term, lawmakers need to find a way to encourage more people, especially those who are healthier, to enroll, said Dr. Martin Hickey, the chief executive of New Mexico Health Connections, one of the few remaining start-up insurers created by the law. He said he was proposing rate increases of anywhere from 20 to 25 percent, although they were proposed before the Senate bill failed.<\/p>\n

\u201cThe pool needs to get stabilized or otherwise we will see year after year of double-digit increases,\u201d he said.<\/p>\n

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Reduce Drug Prices<\/h4>\n

Mark Dalessandro, an adjunct professor at a community college in Tucson, saw his out-of-pocket expenses for the asthma<\/a> medication Advair jump to $292 per month this year from $50 per month last year, after he was forced to switch plans because his insurer, Blue Cross Blue Shield of Arizona, left the market in his area. He said he had little choice but to pay for it. \u201cFor just a month\u2019s supply, for something that helps me breathe, what are you going to do?\u201d he said.<\/p>\n

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Mark Dalessandro, 54, of Tucson, had dealt with fluctuating prescription drug costs.<\/span>
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\n Credit<\/span>
\n Conor E. Ralph for The New York Times <\/span>
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Mr. Dalessandro, 54, pays $405 per month in out-of-pocket costs to cover everything from the Advair to cholesterol<\/a> drugs. That is on top of the $1,462 he pays in monthly premiums for coverage for himself, his wife and his two teenage children.<\/p>\n

The fluctuating drug cost makes him feel as if he were on a \u201croller coaster,\u201d he said. \u201cYou just kind of feel like you can\u2019t get ahead of the game.\u201d<\/p>\n

If there is one health care issue that both Republicans and Democrats have vowed to fix, it is the rising cost of prescription drugs. During the presidential campaign, Hillary Clinton and Mr. Trump railed against outrageous prices set by pharmaceutical executives like Martin Shkreli and drug companies like Mylan, the maker of the EpiPen.<\/p>\n

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