It's time to start new chapter in health care

After nine months of debate over repealing and replacing the Affordable Care Act, it’s time to start a new chapter in the history of access to high quality and affordable health care.

The ACA certainly isn’t perfect. A bipartisan Senate effort to address some of its imperfections was underway until Republican leaders pulled the plug to devote more attention to the latest – and hopefully final – attempt to repeal and replace the 2010 law.

It’s time to reignite that bipartisan discussion and affect some immediate changes.

Most important is stabilization of the individual insurance market. Congress must ensure payments that help offset the cost of co-payments and deductibles for low-income enrollees in plans offered on the insurance exchanges. Failure to do so would raise premiums by 20 percent in 2018, according to the nonpartisan Congressional Budget Office. A second option is to re-establish reinsurance plans that offset the cost of expensive medical treatment.

Lawmakers are also looking at ways to simplify the ACA’s waiver process, under which states can design their own coverage systems within certain parameters. I believe Republicans’ desire to use waivers to provide more state flexibility and Democrats’ desire to protect basic health benefits and consumer protections — including for enrollees with pre-existing conditions — can be accommodated.

There are other challenges with the ACA, including the lack of young and healthy individuals who have signed up for coverage. And, we cannot ignore that too many Americans fall outside the range of financial assistance and are experiencing unaffordable health insurance premiums. With thought, these issues can also be addressed.

That is the work we should be turning to now. Unfortunately, I fear we haven’t heard the last of the concepts embraced in the Graham-Cassidy-Heller-Johnson proposal.

Concepts like block granting Medicaid expansion funds and premium subsidies and capping Medicaid spending at unrealistic levels will almost certainly be back in the future.

Simply stated, Graham-Cassidy would have stolen money from states that expanded Medicaid and given it to states that did not. As an expansion state, Montana would have suffered. Under Graham-Cassidy, the projected net loss to our state was about $1.6 billion between 2020 and 2026.

In addition, the proposed cap to federal Medicaid spending would have widened the current gap between Medicaid costs and payments, and forced Medicaid-dependent nursing homes and hospitals to restrict access or close.

Throughout this year’s repeal and replace debate, Montana Hospital Association members’ top priority has been to preserve health care coverage and access to primary and preventive care. The ACA has enabled more of our friends and neighbors to receive the care they need, at the time they need it. Montana cannot afford to move backwards to a time when the high rate of uninsured fueled concerns about maintaining access to care across our rural state.

Join us in urging Montana’s congressional delegation to commit to collaborating on finding common ground to address our nation’s health care challenges. Your local hospitals, nursing homes and other health care providers are making strides in improving the health of their communities, and it’s time for Congress to get in on the action.

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Dick Brown

President/CEO, Montana Hospital Association