If either of us were building the American health care system from scratch, we’d probably end up in different places.
We have contrasting ideas — one of us is a Democrat, the other a Republican — about what ails the system and how to reshape it. But this is not the time for more partisan fighting. It’s time to build a better system, even if incrementally, because that’s what the American people deserve. It’s time to put aside blame and stabilize a health care marketplace where premiums are expected to rise by more than 15 percent in most states and millions of people are worried about obtaining or affording coverage.
This week the 43-member House Problem Solvers Caucus — which we lead and which is almost evenly split between Democrats and Republicans — released a carefully drafted compromise to shore up the struggling insurance exchanges.
Ultimately, everyone had to give a little and endorse provisions that purists in both our parties may not like. This is how American democracy is supposed to work, even if it has not for quite some time.
Our proposal first focuses on the most urgent crisis: the skyrocketing cost of individual health insurance premiums. The Trump administration is considering suspending cost-sharing payments that defray out-of-pocket payments like deductibles and co-payments for people earning less than 250 percent of the poverty line. Because of uncertainty about this subsidy, insurers have said premiums could rise by 15 percent or more. On Aug. 16, insurers must submit their 2018 rates to state regulators for approval; many may be forced to leave the individual marketplace altogether.
Our plan would stabilize markets by making the cost-sharing payments mandatory and thereby prevent rates from rising sharply.
Second, we provide a relief valve to help states deal with the high cost of pre-existing and chronic conditions. The costliest 5 percent of patients account for nearly half of all health care spending in the country. We propose a dedicated stability fund — essentially a form of reinsurance — that states could use to reduce premiums and limit losses for providing coverage for these high-cost patients.
Third, our proposal provides relief to certain businesses from the mandate that they provide insurance to full-time employees. It also defines “full time” as a 40-hour workweek to discourage businesses from manipulating employees’ weekly hours to skirt the mandate. More than 90 percent of large businesses offered health care before the Affordable Care Act, and studies show that they would continue to do so under this change; others would move to find employee coverage in the individual marketplace.
Fourth, our plan eliminates the Medical Device Tax, an excise charge of 2.3 percent that is often passed onto consumers and reduces funds for research and development. And finally, we provide states with additional flexibility to enter into agreements — such as enabling the sale of insurance across state lines — that would provide more choice and lower costs.
This proposal would not increase the federal deficit, offering several options to offset the new spending.
Our plan isn’t intended to rectify everything that’s wrong with American health care. We aim to solve an immediate problem and move past a seven-year stalemate in Washington that has featured Republicans trying to repeal the current health care law, Democrats trying to preserve it and neither side willing to discuss anything in between.
That approach has led us to our current moment, in which no one is happy with the status quo, least of all the American people, whose trust and confidence in Washington weakens every day that we spend fighting instead of solving real problems.
Health care is one of those problems — and a textbook example of why we formed the Problem Solvers Caucus this year. We all knew the partisanship in Washington had gotten out of control and felt the need to create a bipartisan group committed to getting to “yes” on important issues. We have agreed to vote together for any policy proposal that garners the support of 75 percent of the entire Problem Solvers Caucus, as well as 51 percent of both the Democrats and Republicans in the caucus.
If Washington does not act to stabilize the insurance exchanges, many families we represent will lose coverage or be hit with premiums they can’t afford. This isn’t conjecture.
If that does happen, people will be justifiably livid that Republicans and Democrats in Congress did nothing to stop a train wreck we all saw coming.
There is a growing recognition on Capitol Hill that something must be done, as evidenced by this week’s announcement from Senator Lamar Alexander — the Tennessee Republican who is chairman of the Senate Health, Education, Labor and Pensions Committee — that he will soon hold hearings focused on repairing the individual insurance market.
Our proposal isn’t perfect, but it represents the first and only serious bipartisan health care proposal released in this Congress. We hope our colleagues in the House and Senate, as well as the White House, will use our plan as the foundation for the health care solution that America desperately needs and deserves.
Josh Gottheimer is a Democratic representative from New Jersey. Tom Reed is a Republican representative from New York.