When Donald Trump became president in January, it was widely assumed that the Affordable Care Act (ACA) was running on borrowed time. However, the ACA, which is more commonly known as Obamacare, lives on. Despite four separate attempts to repeal and replace Obamacare by Congressional Republicans -- two in the House and two in the Senate -- Obamacare remains the health law of the land.
Despite of having a majority in both houses of Congress, Republicans, both moderate and far-right leaning, have put the kibosh on any attempts to repeal and replace Obamacare. Moderate Republicans fear that changes to Obamacare would harm their low-income constituents, while Freedom Caucus members are of the opinion that the proposals put forth don't go far enough to repeal Obamacare and distance themselves from the ACA platform. It's left the GOP and Congress in quite the bind.
If Obamacare remains the health law of the land, a number of its flaws could be magnified. This is a result of flaws within the law itself, as well as the Republican Party wanting Obamacare to fail so they can enact reforms. Examples of issues include insufficient young adult enrollment, the failure of a risk corridor, and the inability of each state's Office of the Insurance Commissioner to push back against insurer premium-increase requests on the behalf of consumers.
Can Republicans and Democrats work together?
As we've seen, having a Senate majority doesn't guarantee a bill's passage. Instead, Republicans and Democrats may have to, dare I say, work together to formulate a new healthcare plan that works for both parties and Americans alike. Crafting a bipartisan healthcare bill would undoubtedly be difficult given how far apart the GOP and Democrats are when it comes to the future of healthcare. However, there are a handful of Republican healthcare reform ideas and proposals that Democrats may be willing to agree to or work with.
1. Boosting HSA contribution limits and allowing them to be used for premium payments
Thus far, all iterations of the GOP's healthcare reforms have included a substantial increase to the amount individuals and families can sock away annually in a health savings account, or HSA. HSAs are tax-advantaged accounts that allow people to pay for eligible medical expenses on a tax-free and penalty-free basis. In 2017, HSA contribution limits are set at $3,400 for individuals and $6,750 for families, but the latest Republican proposal implied increasing these limits to $6,650 for individuals and $13,100 for family coverage this year. I doubt there's anything specific about raising the HSA contribution limit that Democrats would oppose.
Even more interesting, the latest Republican proposal suggested allowing HSA accountholders the opportunity to pay their health insurance premiums with HSA money. Since HSA money is tax free, it's not a guarantee that Democrats would go along with this idea. However, angling health saving accounts toward the middle class, and offering an incentive of being able to use tax-free funds to pay for health-insurance premiums, could be a one-two punch that both parties could get behind.
2. Providing funding for an opioid treatment fund
The most recent Republican healthcare proposal, dubbed the Better Care Reconciliation Act (BCRA), set aside $45 billion to help fight opioid addiction, at the request of multiple GOP senators. Prescription opioids are often used to treat chronic pain, but according to the American Society of Addiction Medicine, 20,101 people lost their lives to opioid overdose-related death in 2015. It's an addiction that obviously has a human toll, as well as an economic toll on the healthcare system and the labor force via lost productivity.
Democrats would probably be in favor of reform efforts that would funnel money specifically to fighting opioid addiction. It doesn't matter whether we're talking about blue or red states -- prescription opioids are a serious problem. In fact, the Food and Drug Administration (FDA) recently requested that Endo International pull opioid medication Opana ER from pharmacy shelves. The regulatory agency determined that the risks of the medication now outweighed its benefits.
Where the funding would come from for an opioid prevention fund is anyone's guess, but it's a proposal that could have a positive long-term impact on healthcare costs.
3. Block-granting Medicaid to the states
Republicans tossed around two ideas when it came to disbursing Medicaid funds to the states: block grants and per-capita disbursements. The latter, which is what the GOP chose to include in the BCRA, distributes federal funds to states based on the number of Medicaid enrollees they have. Block-granting money would send a fixed amount annually to the states, and allow those states to decide how the money should be spent.
Block grants were first suggested by President Trump during his presidential campaign. The allure of block grants is that they put states, not the federal government, in charge of where Medicaid funds wind up. States would have more control over who qualifies for these funds, which should result in less waste, allowing federal dollars to go farther. This pathway is certainly appealing to members of the Republican Party, and it might have a chance at garnering support with more moderate Democrats, who'd appreciate states having more liberties in setting the guidelines for who qualifies for certain Medicaid services.
One sticking point that may be too great to overcome
However, the great sticking point in any bipartisan healthcare effort is going to be the future of Medicaid. Put plainly, the GOP absolutely needs cuts from the Medicaid program in order to pass tax reforms that would reduce tax rates on most individuals and corporations. On the other hand, Democrats are probably going to dig in their heels and reject any attempts to significantly reduce the amount given to fund a program that primarily covers low-income Americans.
Can a compromise be found concerning Medicaid? That remains to be seen.
For what it's worth, this Fool believes fixing Obamacare might be an easier path than coming up with a completely new plan, but this, too, would require humbling concessions from the GOP that I don't believe they're willing to give up at the present.
What's this mean for you, the consumer? Unfortunately, the likelihood of higher premium prices in the near term. The more uncertainty that exists in the healthcare marketplace, the less likely insurers are to remain on the ACA exchanges, thus reducing competition and driving up premiums. With no assurances that key subsidies will remain in place beyond 2017, or that Obamacare will even remain sustainable over the intermediate term, it's the consumer who'll suffer.