COLUMN: The best path forward on healthcare
It has been eight years since the implementation of the Affordable Care Act (ACA), and in that time, those living in Colorado’s Third District have seen their healthcare steadily become less affordable and less accessible than ever before. Since 2013, the year ACA exchanges opened in Colorado, individuals in the Third Congressional District have had health insurance premiums increase by an average of 42 percent. These high premiums have been compounded by skyrocketing deductibles, which under the cheapest plan, cost $6,000 on average nationally.
As a direct result of the ACA’s failures, in 2017, many insurers announced that they would depart the exchanges, leaving a large number of counties across the country with just one insurer on the exchanges in 2018. We have seen this firsthand in the Third District, as there are now 14 counties where families have only one insurance carrier to choose from in the individual market. This government-driven competition drought does not lead to decreased costs for consumers, but only to decreased options at higher costs.
For many families, premiums have surpassed the cost of their home mortgage, and they cannot afford the limited options in their area. This has left too many with the difficult choice of choosing between which bills to pay. It was very telling when millions of Americans chose to pay a fine and go without health insurance, rather than enroll in a plan under the ACA.
When the ACA was passed, I have no doubt that the goal of those involved was to improve access to affordable healthcare. Unfortunately, it failed miserably and had the opposite effect.
The ACA is not working, so where do we go from here?
There are two ideas we hear about often – repealing and replacing the ACA with a market-based health insurance system to drive down costs and increase options, or completely handing healthcare over to the government by creating a single-payer system. The first option supports choice and competition, the second has the potential to be catastrophic for Americans.
Last year, a bill to create a single-payer system and put the government in charge of the nation’s entire healthcare system was introduced in the Senate. Following the introduction of this bill, an analysis placed a $32.6 trillion price tag on the implementation of a single-payer system over the first 10 years. This is a colossal cost, which would subsequently become a colossal burden for the American taxpayer as the same analysis found that even if the current federal, individual and corporate income tax collections were doubled, there would still not be a sufficient amount of funds to cover the cost of single-payer healthcare.
If we are to learn anything from the failures of the ACA, it is that a one-size-fits-all healthcare system cannot adequately meet the needs of over 300 million Americans. Rather than a single-payer system, we must implement a patient-centered healthcare system that drives down healthcare costs, and puts individuals and families back in charge of their healthcare decisions. In the Tax Cuts and Jobs Act, we effectively repealed the ACA individual mandate so that those who could not afford the outrageous plans under the ACA would not then also be penalized by government because of it. This was a good first step.
As we replace the ACA I believe that there are some critical elements that will help drive down healthcare costs and improve options for all Americans, while ensuring that those with pre-existing conditions have access to the care they need.
Healthcare savings accounts (HSAs) and flexible savings accounts (FSAs) give people more flexibility in the way they spend their healthcare dollars. We should make it easier to use these tools by raising the caps on HSA and FSA contributions. We should also allow insurance carriers to customize plans that work for Coloradans – this will require the state of Colorado, not the federal government, to set the essential health benefits that every insurer must offer when selling plans in the state. Increased flexibility will bring more insurers to the market, increasing competition and driving down premiums.
Additionally, I believe that giving small businesses and associations the opportunity to band together to establish health plans will help provide consumers with more options. For example, there are many people in the West who are part of an organization like a rural electric co-op or an association like the U.S. Cattlemen’s Association – they could come together and establish an association health plan. Last year, I worked in the House to pass two bills that would help give Coloradans this option: The Competitive Health Insurance Reform Act (H.R. 372), and the Small Business Health Fairness Act (H.R. 1011). Both bills would help associations establish health plans that can be offered to members in multiple states.
Ensuring individuals with pre-existing conditions have access to affordable health insurance is something I have always fought for. At some point in our lives, we are all going to have a pre-existing condition. Prior to the ACA, the Health Insurance Portability and Accountability Act (HIPAA) prohibited insurance companies from denying insurance to any individual with a pre-existing condition who was transferring between group markets. I will continue to insist that these protections be extended to the individual market in any healthcare plan that comes before Congress. Giving states resources to establish tools like high-risk pools and reinsurance programs is also a priority. These resources are designed to ensure individuals with pre-existing conditions and high healthcare costs can get insurance, and they are critical as we address the challenges created by the ACA.
I am also committed to ensuring that individuals who have disabilities have access to affordable home care so they can maintain their independence. Under current law, most insurance programs only cover long-term institutional placements, not home or community-based care. I have had the opportunity to speak with advocates across the State of Colorado about the benefits of long-term home and community-based care and am a cosponsor of the Disability Integration Act (H.R. 2472). The bill would give individuals with disabilities the right to receive long-term support services in their homes or a community setting, rather than an institution. I would like to see H.R. 2472 included in future efforts to strengthen the healthcare system.
The failed government healthcare program must be replaced, and there are two paths before us: one that supports choice, drives down costs and increases competition, and one that puts the federal government in charge of everyone’s healthcare decisions and adds $32 trillion in unfunded mandates over the next 10 years, requiring income tax collections to more than double as a result. The best path forward will give Coloradans the ability to purchase a plan that works for their needs, lower costs and improve accessibility.