California Forum

Here’s a bipartisan approach of simple fixes to reform health care

Los Angeles Times

When it comes to health reform, we don’t agree on much. As the former executive director of the National Federation of Independent Business in California, and as the former external affairs director for Covered California, we’ve mostly been on opposite sides of the table.

In numerous public forums, we’ve debated the question of how best to fix our health care system. We argued about the solution, but we did find common ground on something: Providing affordable, quality health care is critical for our nation.

The national debate on health care climaxed recently with the decision by House Speaker Paul Ryan and President Donald Trump to withdraw their proposed “American Health Care Reform Act.” This critical turning point offers an opportunity to try something we haven’t tried in a long time – a bipartisan approach.

If Obamacare is here “for the foreseeable future,” as Ryan forecasts, there are some simple fixes that can make a big difference. For the 20 million Americans who depend on the individual health insurance marketplace for their coverage, inaction is unacceptable.

When the supercharged hyperbole about the Affordable Care Act is pulled back, it is easier to reach agreement on the problem so that work on incremental solutions can begin. To start with, there are actions Congress can take.

Stabilize the marketplace: Health plans are risk averse. They loathe uncertainty. In smaller risk pools, a few high-cost patients can have a major impact on rates. Reinsurance is a tool worth consideration that minimizes risk and can help stabilize the marketplace. It worked well for the Affordable Care Act’s first three years but expired last year. That partly explains why some states saw major premium spikes. The administration should also weigh the idea of allowing states to apply for state innovation waivers that will allow them to pursue innovative strategies that best suit their individual needs to give their residents access to quality, affordable health insurance.

Improve affordability: Finding ways to lower insurance premiums and deductibles and other out-of-pocket costs is essential, especially for low-income consumers who get sick and need care. The Affordable Care Act provides an extra income-based sliding scale federal subsidy to keep these costs low. But funding for the so-called Cost Sharing Reduction plans is now in limbo.

The House of Representatives challenged the legal authority of the Obama administration to provide these payments, and the court case is pending. Resolving the litigation and moving forward with Cost Sharing Reduction plan funding is critical for the 6 million Americans who depend on this assistance. And we most certainly need to give American small businesses greater flexibility to design health plans that work best for them.

More choice of plans: Particularly in rural areas, consumers are left with only one health plan – and therefore don’t have a choice. This is harder to fix, but Covered California has shown it can be done. The California exchange leverages its purchasing power to incentivize health plans to compete in underserved parts of the state.

In fact, in California, all exchange consumers have at least two plans to choose from, and 92.6 percent are able to choose from three or more plans. For smaller states, temporary financial incentives may be necessary for those low-service or rural areas that are currently underserved by health plans.

Over the long haul, we also must begin to address the underlying cost drivers that result in higher health care expenditures and premium increases. We also need to find better ways to provide care for the 5 percent of the patients with complex, chronic conditions that drive 50 percent of the costs. We believe there is bipartisan appeal for finding pathways that result in reduced costs, improved care and better health outcomes for patients.

Health care is too important to be viewed as a political football to be kicked up and down the field. There are those on the left who believe that Affordable Care Act is fundamentally flawed because it relies too much on private health insurance; they hope the ACA will blow up to pave the way for a single-payer approach. There are those on the right who believe the ACA is fundamentally flawed because it relies too much on government mandates instead of free markets; they hope the law blows up to pave the way for a full repeal.

Both scenarios place Americans who need health care in the middle of an ideological war that jeopardizes their care. We can’t let them become collateral damage when there are common-sense solutions that are workable, practical and implementable if there is bipartisan willingness to do so.

John Kabateck, former executive director of the National Federation of Independent Business in California, is president of Kabateck Strategies. He can be contacted at David Panush, former external affairs director for Covered California, is president of California Health Policy Strategies. He can be contacted at