August 24, 2017 | Rosemarie Day

What’s Next for Health Reform: Bipartisanship, and Moving to the State Level

Over the last few months, Republicans in the House and the Senate have been unsuccessful in repealing and replacing the Affordable Care Act (ACA). With the latest failure in the Senate, the attention is shifting to a focus on bipartisan and state level solutions.

This is a welcome shift.  I believe the best thing the country can do now is support the following pragmatic, bipartisan solutions to the ACA’s problem – these are my top 3:

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These solutions already have a fair amount of support.  There are champions in the House (through the Bipartisan Problem Solvers Caucus [1]), in the Senate (through the health committee leadership’s push to hold bipartisan hearing in early September), among various policy thinkers [2], and in state governments (through bipartisan Governors meetings).  And polls show that the public is also increasing its support of protecting the ACA [3] and having government ensure that all Americans have health care [4].

One of the best ways to accomplish these pragmatic solutions is to allow states to innovate.  This could be accomplished by loosening some requirements to allow states greater flexibility in innovating. The waivers permitted under Section 1332 of the ACA are one of the main vehicles for this innovation.  States like Iowa and Oklahoma are submitting Section 1332 Waivers to the federal government to help stabilize their insurance markets, as well as some other things [5]. These waivers can make a significant impact, though there needs to be a balance.  The waiver process, if used too permissively, could end up undermining some of the core principles of the ACA, including ensuring adequate benefit coverage.

It’s important to balance flexibility and guardrails when looking at loosening the requirements for state waivers. We should protect the core principles of the ACA to ensure that people are have access to affordable and quality health insurance. However, states should be given some leeway to make the tradeoff that makes sense for their state. This balance will take some compromise from both sides.

Thank you to Emily Eibl for her contribution to this blog.