The nation breathed a collective sigh of relief last week when Senate leaders grudgingly decided not to proceed with their latest proposal to repeal the Affordable Care Act (ACA). It is unlikely they will give up on the idea of turning back the clock, but most Americans and virtually every health care leader made it very clear that they want the country to move forward. They want to keep what is working under the ACA and find bipartisan solutions to fix what is not.
Under normal circumstances, the upcoming health insurance enrollment period would be one of the best opportunities to move the nation forward. Unfortunately, federal administrators seem to be doing everything they can to hurt enrollment through the national Healthcare.gov website. They have drastically cut outreach funds and plan to shut down the website at key times during high-traffic weekends in a sign-up period they already shortened.
Stop Starving Enrollment
These decisions are counterproductive and likely mean fewer individuals will enroll, which could ultimately result in higher premiums for consumers. Covered California, which runs California’s health insurance exchange, has had a strong commitment to enrollment from the beginning. For every $1 Covered California spends promoting enrollment, consumer premiums are reduced by $3, the agency found. Emboldened by those benefits and concerned about federal sabotage, Covered California has increased its marketing and outreach budget and maintained an extended sign-up window for this year’s enrollment period. But if California succeeds while the nation suffers, it will be a fragile victory.
The enrollment issue, however, is about more than a return on investment — it’s about basic good government. The ACA is the law of the land, and elected and unelected officials have an obligation to implement it in good faith. Ordinary Americans do not get to pick and choose which laws they will follow. Our government leaders should be held to the same standard.
Make the Most of Medicaid
To date, 31 states and the District of Columbia have expanded Medicaid under the ACA, helping cut the number of uninsured Americans in half. It means that every day, millions of people are getting care they desperately need. Medicaid allows us to provide for our families and to contribute to the economy. Expanding Medicaid has increased stability in states’ private health insurance markets. And Medicaid already gives states flexibility to tailor their approaches to local needs. Every state holds the power to use this existing opportunity to expand Medicaid, and states should exercise this authority to help their citizens and the nation as a whole.
California has benefited enormously from expanding its state Medicaid program, known as Medi-Cal. We have an opportunity to build on that progress and make it durable by taking steps to make Medi-Cal more effective and more cost-effective, especially in delivering care to the most vulnerable Californians. We may have limited influence over decisions in other states, but we can serve as a model at a time when health care leadership is sorely needed.
Bring Back Bipartisanship
Finally, House and Senate leaders need to address specific problems by giving bipartisanship a real chance to succeed. That starts with renewing funding commitments to the Children’s Health Insurance Program (CHIP) and the Community Health Center Fund, both of which have always enjoyed broad bipartisan support. CHIP provides health coverage to children and pregnant women from low- and middle-income families who earn too much to qualify for Medicaid. The Community Health Center Fund is a lifeline for thousands of local health clinics, which together provide vital care to 27 million people. On September 30, Congress allowed funding for CHIP and the health centers to lapse. There is no excuse for dropping the ball on these crucial programs, which help many millions of people. Our lawmakers must work together to make things right.
Regarding the bigger challenge of fixing the ACA, we have been encouraged by the good-faith proposals from Republican and Democratic governors and by the nascent bipartisan negotiations in Congress. There is plenty of common ground for targeted solutions to help protect Americans from increasing health care costs — including permanent adoption of cost-sharing subsidies and creating new federal risk-sharing mechanisms.
We may not agree with every idea produced by bipartisan negotiations, but we understand that health care is complicated. Only by working together is there a chance to make health care work better.
Dr. Sandra R. Hernández is president and CEO of the California Health Care Foundation. Prior to joining CHCF, Sandra was CEO of The San Francisco Foundation, which she led for 16 years. She previously served as director of public health for the City and County of San Francisco. She also co-chaired San Francisco’s Universal Healthcare Council, which designed Healthy San Francisco, an innovative health access program for the uninsured.
Sandra is an assistant clinical professor at the University of California, San Francisco, School of Medicine. She practiced at San Francisco General Hospital in the AIDS clinic from 1984 to 2016. She was appointed by Governor Jerry Brown to the Covered California board of directors in February 2018. She currently serves on the Betty Irene Moore School of Nursing Advisory Council at UC Davis and the UC Regents Committee on Health Services. Sandra served on the External Advisory Committee at the Stanford Center for Population Health Sciences in 2016. Sandra is a graduate of Yale University, the Tufts School of Medicine, and the certificate program for senior executives in state and local government at Harvard University’s John F. Kennedy School of Government.