On March 26, 2019, in the midst of Affordable Care Act invalidation discussions, Speaker of the United States House of Representatives Nancy Pelosi announced a wide-ranging health care proposal that would further cement the ACA, and perhaps even taken it a step further.
The Proposal
The proposal reaches multiple facets of the health care industry, including attempting to reduce health care premiums by capping out-of-pocket costs at 10 percent of income and expanding tax credits for those beyond 400 percent of the federal poverty line. It also creates a national reinsurance program in an attempt to offset high medical bills for insurers and attempt to keep premium increases from continuing to rise.
The bill also reinstates the “preexisting condition guarantee” where those with pre-existing conditions are guaranteed to be covered. It also disallows non-ACA compliant plans from being sold and reaffirms the list of essential health care benefits that are to be covered by all plans, originally found in the ACA. The proposal also requires the current administration to budget federal money for enrollment outreach, a budget that has been dramatically cut since the Trump Administration came to Washington.
One thing that some may find “missing” from the bill is the failure to restore the cost-sharing payments to health insurers that the Trump Administration ended. This is not an oversight, but is intentional, as many have wound up receiving greater federal aid without the cost-sharing payments.
According to a senior aide, the bill is not likely to be passed as a single package, but instead is likely to be brought up for discussion in individual provision pieces. This will also allow members of either political party to show where they stand on certain issues as it relates to health care.
It should be noted that the proposal does not make any mention of “Medicare for All,” a popular concept embraced by many on the left-leaning side of the political aisle. This was likely by design, as Pelosi has been known to oppose the concept of single-payer, raising questions about how it would be paid for. However, the door is not closed, as the senior aide mentioned earlier also noted, “This doesn’t displace a discussion about a public option, a Medicare buy-in, Medicare-for-all.”
Support
Some political groups have already come out in support of the proposal, including Protect Our Care, a progressive group, who stated, “In all, the bill’s extended tax credits, reinsurance programs and premium assistance would cut premiums for all ACA-compliant plans sold on the individual market, reducing premiums or deductibles for 13 million with individual market coverage and creating lower cost options for 12 million uninsured people eligible for coverage through the marketplace.”
Opposition
However, like many topics in Washington, DC today, this is not a slam-dunk proposal fully supported by either side of the “political aisle.” Republicans have long been trying to invalidate the ACA and have it declared unconstitutional, while progressives like Bernie Sanders want to get rid of everything and institute single-payer health care.
Conclusion
Even if the bill passes the Democrat-controlled House of Representatives, it is surely dead on arrival in the Republican-controlled Senate. The introduction of this bill may simply be a political move to hold elected politicians’ feet to the political fires the base of either party are lighting up.