Federal administrative improvements to the Affordable Care Act and state options for health care reform
This publication is an abbreviated version of the Policy Brief “Federal administrative improvements to the Affordable Care Act and state options for health care reform” that will be published by Washington Policy Center in January 2018. You can find the complete Policy Brief here.
Policy recommendations
Patients are the most important part of the health care system and they should be in charge of their own health care. There is nothing inherently different about health care as a service than any other economic activity. Health care providers should be paid for their work, and to the extent possible prices for health services should be set, not by government, but by economic efficiency and the natural movement of supply and demand in the market. There are practical steps that would put patients in charge of their health coverage without complete repeal of the ACA:
1. Reform the ACA through Administration and incremental legislative actions. • promote greater use by the states of 1332 and 1115 waivers.
- promote greater use by the states of 1332 and 1115 waivers.
- provide patient-centered alternatives, such as health savings accounts and catastrophic health insurance plans, to the essential health benefits in the ACA.
- extend the use of short-term, limited-duration health insurance plans.
- allow the purchase of health insurance across state lines.
- expand the definition of “hardship” cases to blunt the restrictions of the individual mandate.
- promote state high-risk pools to cover high-cost patients and pre-existing conditions.
- allow greater use of association health plans to give small employers and individuals the same insurance price and benefit advantages of large employers.
- permanently withdraw the cost-sharing reduction subsidies and allow the exchanges to collapse sooner rather than later. Because of adverse selection, the exchanges are currently in a financial death spiral. More taxpayer money will not improve the long-term outlook of the exchanges.
- repeal the Obamacare taxes.
2. Promote price transparency, so patients become true consumers of health care and know the real cost of the services they are receiving.
3. Change the tax code and allow equal treatment for individuals and families, so they can benefit from the same tax deductions that employers now receive for providing employee health benefits.
4. Enact meaningful reform of Medicaid and Medicare entitlements and make them true, targeted, safetynet programs, as they were originally designed.
