Beyond ‘repeal and replace,’ area GOP lawmakers offer prescription for improving ACA


    After years of promising to “repeal and replace” the Affordable Care Act, some Republicans in Congress are now using the “S” word.

    “My perspective is we need to stabilize it,” said U.S. Rep. Ryan Costello, who represents Pennsylvania’s 6th District, primarily in Berks, Chester and Montgomery counties.

    Costello — along with U.S. Reps. Brian Fitzpatrick from Bucks County and Patrick Meehan from Pennsylvania’s sprawling 7th District — is promoting a bipartisan plan to shore up the embattled law. The lawmakers previously voted against the House Republican plan to replace the health law, which the Congressional Budget Office estimated would lower the number of insured Americans by 24 million.

    After further attempts by Senate Republicans to end the Affordable Care Act stalled last week, a group of more than 40 lawmakers in the House called the “Problem Solvers Caucus” released the five-point proposal Monday. Republican U.S. Reps. Lloyd Smucker from Lancaster County and Charlie Dent from Lehigh County are also among the stabilization plan’s proponents.

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    In brief, those points are:

    Mandate “cost-sharing reduction” subsidies, which the federal government pays to insurers to offset the cost of covering low- and middle-income consumers.
    Create a “stability fund” to help insurance companies cover the costs of the most expensive patients, including those with pre-existing conditions.
    Increase the threshold for the employer mandate to businesses with 500 employees from the current 50.
    Repeal a 2.3 percent medical device tax.
    Create guidelines for insurers that wish to operate across state lines.

    Analysts say the most critical part of that plan is making sure the federal government keeps paying the cost-sharing reduction subsidies, which will total $7 billion this year, according to the Congressional Budget Office.

    President Donald Trump has threatened to end these subsidies, which could lead insurers to raise premiums by nearly 20 percent to cover their costs and effectively gut the marketplace.

    The plan’s first two tenets encourage insurers and consumers to continue participating in the volatile marketplace.

    “In general, these are common-sense fixes to the market, so that insurance companies that are involved, stay involved, and that they are able to keep their premiums at a reasonable level,” said George Washington University professor Sabrina Corlette.

    The easing of the employer mandate also acknowledges that the regulation may not be necessary — most employers offer insurance to compete for skilled workers, not because they’re required to, said Corlette. As for the medical device tax, it is one piece of funding for the original law that has been assailed by medical device lobbyists.

    But the success of this or any new health care legislation depends as much on who is working on it as what it contains — and whether Republican leadership in either house will bring it to a vote.

    “The single most important thing that makes it valuable is that it has bipartisan support,” said Len Nichols, professor of health policy at George Mason University. “We have to move beyond Republicans denying that the ACA helped a lot of people, and we have to move beyond Democrats denying that the ACA hurt a few people.”

    The U.S. Senate seems to be picking up that bipartisan baton, announcing Tuesday that its health committee will hold discussions on stabilizing the insurance marketplace with Democrats and Republicans starting in September.

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