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He end of closure delivered something rare in Washington: a second chance at proper health care. As part of the deal to reopen the government, Senate Majority Leader John Thune, R-S.D., pledged to hold a vote in December on extending enhanced premium tax credits in the individual market. That creates an opportunity to avoid steep premium increases and begin building a system that works better for patients.
For Democrats who voted to end the shutdown, the incentives are simple. They want to show that their commitment creates real relief for families facing higher premiums. They will seek a deal that solves the problem before them, but will back down if Republicans turn the bill into another fight over repealing the Affordable Care Act (Obamacare). The task now is to fix what is broken, not revisit old conflicts.
This moment also gives Republicans a chance to show they can govern. Health care costs are a major driver of the affordability crisis facing families. They reduce take-home pay, increase the price of goods and services, and put both households and governments further into debt. Employers, who bear most of the costs of coverage for people under 65, feel the pressure directly, and workers feel it in their paychecks.
President donald trump has already outlined an important principle: Instead of funneling federal subsidies through insurance companies, direct that support to people so they can choose the care and coverage that works best for them. Florida Republican Senator Rick Scott has made a similar argument, calling on Republicans to fix Obamacare. Combined with growing bipartisan support for price transparency, these ideas point toward a practical strategy that empowers patients and employers and fosters a more competitive marketplace.
SEN DICK DURBIN: DEMOCRATS FIGHT TO PROTECT HEALTH CARE AS TRUMP AND REPUBLICANS PLAY SHUTDOWN
Republicans have a chance to finally fix the healthcare system. (iStock)
The current system is moving in the other direction. Prices are hidden, administrative tiers continue to expand, and incentives are misaligned in ways that guarantee prices will rise year after year. These problems are especially acute in the individual market, which has fewer participants, a less healthy risk pool, and limited plan competition. Getting this marketplace up and running again requires more enrollment, more choice, and more transparency.
The December vote is the right time to begin that change. A package that addresses the immediate issue of subsidies and lays the foundation for long-term reform is achievable and necessary. There are practical solutions already developed by center-right institutions such as the America First Policy Institute, the Paragon Institute, leaders in Congress and Trump’s political proposals.
The first step is a responsible elimination of enhanced premium tax credits through 2026. This avoids an abrupt cutoff and gives the rest of the reforms time to take effect.
REPUBLICANS DIRECTED THEIR ATTENTION TO ATTACKING OBAMACARE AS THE SHUTDOWN ENTER DAY 39
Second, Congress should adopt a proposal from the Paragon Institute to restore and reform Cost-Sharing Reduction (CSR) payments in Obamacare, giving qualified enrollees the option to receive their CSR subsidies directly into a health savings account (HSA). This change addresses several problems at once.
Reduces premiums and reduces federal costs. When CSR payments were suspended in 2017, insurers responded by dramatically increasing premiums for silver plans, a practice known as “silver loading.” Because premium tax credits are tied to the price of silver plans, this increased federal spending. A 2018 analysis by the Congressional Budget Office found that restoring CSR funding would reduce the federal deficit by about $30 billion over a decade. Providing financing is less expensive than continuing with the current solution.
It also creates the budget space needed to phase out enhanced premium tax credits responsibly. The savings could be used to fund the phase-out or to provide more generous contributions to HSAs by CSRs to strengthen support for low-income Americans.
Most importantly, it empowers patients. According to Paragon, the typical annual HSA contribution for someone receiving CSR assistance would be approximately $2,000. This is significant support that families can directly control. If they stay healthy, unused dollars remain in the account and continue to grow. If they get sick, they can use the funds to cover out-of-pocket expenses. Because the money belongs to them, they have a clear incentive to compare prices and choose high-value care, which encourages greater competition among providers.
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Next, Congress should strengthen the individual market’s risk pool by expanding affordable options. That means allowing any health plan approved by the state insurance commissioner to be listed on the exchanges, expanding access to copper plans, adjusting age rating rules so younger people pay less, and modernizing individual coverage health reimbursement arrangements (ICHRAs) so more small businesses can offer coverage. Practical changes, such as allowing employees to choose between an ICHRA and a traditional group plan, allowing employees to contribute pre-tax dollars to close premium gaps, and eliminating unnecessary COBRA requirements, would make ICHRAs more attractive.
The first step is a responsible elimination of enhanced premium tax credits through 2026. This avoids an abrupt cutoff and gives the rest of the reforms time to take effect.
Finally, these reforms should be accompanied by the Bipartisan Patients Deserving Price Tags ActSponsored by Kansas Republican Senator Roger Marshall and Colorado Democratic Senator John Hickenlooper. The bill would strengthen enforcement of price transparency rules so that small businesses, self-funded employers, and new purchasing groups can contract directly with transparent providers and pharmacies. This would reduce costs, eliminate intermediaries and increase competition.
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This is a time to govern practically. He The shutdown agreement not only reopened the government. He opened a door. If Republicans seize this opportunity, they can solve a real problem for millions of Americans and begin a long-awaited transition toward a health care system that puts patients, not bureaucracies, in charge.
december vote It could be the beginning of that transition. It should be.
Disclaimer: Gingrich 360 has consulting clients in the healthcare industry that may be affected by changes in healthcare laws.
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