Republicans have failed to repeal and replace the Affordable Care Act. Now, can it be repaired?
The seven-year-old law has survived Supreme Court decisions and aggressive attempts to extinguish it by Republicans in Congress and the White House. But even people who rely on its coverage agree that it still has big problems. The question for the roughly 20 million Americans who buy their own health coverage — and for millions of others who remain uninsured — is what can realistically be done to address their main concerns: high prices and lack of choice in many parts of the country.
The politics are exceedingly tricky in a divided and dysfunctional Washington, but economists, insurers, doctors and health policy experts across the political spectrum agree that immediately addressing basic shortcomings in the existing system would go a long way toward making the law more effective and financially stable.
There is widespread agreement that the first order of business is to calm very jittery insurance markets. Guarantee continued funding to reimburse insurers for waiving deductibles and co-payments for low-income customers, as the health law requires companies to do. The Trump administration has threatened to stop making the payments.
If these so-called cost-sharing reductions are not paid for the remainder of the year or in future years, people will see premiums go up by nearly 20 percent to cover them, according to the Kaiser Family Foundation.
While insurers are hopeful that Congress will pass legislation guaranteeing the payments, they want a commitment to support the insurance markets. Are they going to sabotage the market or are they going to help the market?
The fundamental problem that many insurance customers face is sky-high deductibles or premiums that are simply out of reach. One of the best quick fixes that is not controversial is reinsurance. That would involve the government helping insurers pay for the sickest, most expensive people, whose costs can drive up premiums in places where there are not enough healthy customers to balance them out.
If there is one health care issue that both Republicans and Democrats have vowed to fix, it is the rising cost of prescription drugs. But there is little agreement on the best way to fix the problem. Democratic proposals, such as allowing Medicare to directly negotiate drug prices with pharmaceutical companies and allowing cheaper drugs to be imported from overseas, are fiercely opposed by the drug industry, as well as Republicans in Congress. And though Mr. Trump has criticized the industry, his administration has not yet put forward a plan to address the issue.
There is bipartisan support for measures that would speed more generic drugs to market, including a proposal that would crack down on brand-name manufacturers that bar generic companies from gaining access to the samples they need to make copycat versions.
Although the Affordable Care Act has greatly expanded access to coverage — the nation’s uninsured rate fell to 10.9 percent last year, according to Gallup, from 17.1 percent in late 2013 — many Americans remain shut out.