After months of discussions and planning, followed by a crescendo of news coverage, six governors released the details behind a bipartisan “blueprint” for health care changes. Acting in response to the federal government’s inability to reach consensus about how to fix rising costs, lack of competition and insurance affordability, the governors’ plan addresses corrections to the insurance industry.
Colorado’s John Hickenlooper was one of the six governors helping craft the guidelines, along with John Kasich of Ohio, Brian Sandoval of Nevada, Tom Wolf of Pennsylvania, Bill Walker of Alaska, Terence McAuliffe of Virginia, John Bel Edwards of Louisiana and Steve Bullock of Montana.
So what’s in the plan?
1. Keep the individual mandate “for now.” Essentially, it calls on Congress to retain the individual mandate requiring people to have health insurance or pay a fine on their taxes. The plan says it “is perhaps the most important incentive for healthy people to enroll in coverage.” The governors want the states to be able to come up with their own plans and request waivers. And, they say Congress should come up with an alternative.
2. In counties with only one insurance carrier, the governors are asking Congress to encourage competition by exempting insurers in underserved areas from the federal health insurance tax. They also want Congress to allow rural residents with liited options access to federal coverage.
3. They also want Congress to create a temporary fund to stabilize premiums and limit losses. The governors agree with recent plans in Congress to provide $15 billion a year to address coverage with the goal of lowering premiums. They also want to continue to make the cost-sharing payments required under the Affordable Care Act. The Congressional Budget Office says that failure to do so could drive up premiums in the individual market by 25 percent and increase the national deficit by $194 billion during a 10-year period.
4. The government should continue efforts to encourage healthy people to enroll in insurance markets and should also limit participation in the exchange for people who are eligible for other programs like Medicare or Medicaid.
5. Give states greater authority to regulate markets. “The federal government should not duplicate efforts or preempt state authority to regulate consumer services, insurance products, market conduct, financial requirements for carriers and carrier and broker licensing in states that already effectively perform these functions,” the report said.
6. States can opt out of parts of the ACA if they can prove their actions won’t increase the deficit, won’t increase the number of uninsured people and won’t reduce affordability. The governors want to allow individual states to develop their own plans. Congress should create a way to streamline and fast-track the waiver process.
7. Pay health care providers based on quality of services, not quantity of tests. Some states are already moving in this direction, the plan says, and asks Congress to embrace payment reforms, while also encouraging transparency in the cost and quality of care.
“We strongly encourage that Congress and the administration take immediate action to stabilize the individual health insurance marketplace,” the report said. “If there is a clear signal to consumers and carriers that the individual market is viable, additional state-based reforms will be more manageable and we can succeed in preserving recent coverage gains and controlling costs.”
But the governors’ plan doesn’t address all the underlying reasons for rising costs in health care. There’s no mention of tort reform, so doctors and hospitals will be forced to practice defensive medicine and order unnecessary, expensive tests to make their malpractice insurance carriers happy and keep attorneys at bay.
The plan doesn’t discuss the lack of access to care. Doctor and nurse shortages are common throughout Colorado — especially in the state’s rural areas. There are no incentives for health care providers to move to rural areas, no efforts to increase access in inner cities or to provide more affordable paths to medical school for general practitioners. The costs can’t go down until access and availability are addressed alongside tort reform as well as the changes to the individual markets addressed in the governors’ plan.
Despite its shortcomings, the blueprint for health care is a bipartisan effort to address a complex issue in the individual market that affects small and micro businesses, as well as people working as independent contractors, freelancers and others who buy their coverage through the individual insurance market.
It’s a good start — and now it’s up to Congress to move forward with a bipartisan plan that doesn’t harm the poor, hurt working families or damage business profits.