Premium increases hitting those in the narrow individual health insurance market put a necessary spotlight on the Affordable Care Act's flaws. But as efforts to repair the law — or repeal it — ramp up with the recent confirmation of U.S. Health and Human Services Secretary Tom Price, it is important to remember that the ACA also benefited millions of Americans.
The uninsured rate plummeted to historic lows nationally and in Minnesota. And while the spotlight was often on those hit by price hikes, the stories of those helped by the law often didn't get told. Among them: Brad and Karen Johnson, two Champlin retirees who are too young for Medicare, the popular government-run program for those 65 and up.
Brad, who taught school for 34 years, turned to the individual market when continuing coverage through his employer's COBRA plan proved too pricey. Coverage through MNsure was far more affordable thanks to the ACA's tax credits, which now save the couple about $600 a month, dropping their premiums to slightly less than $500 monthly. The assistance allowed them to conserve the money saved before retirement. When Karen needed hip replacement surgery, they met their deductible with ease.
The Johnsons' story is not only a reminder of the ACA's benefits, but a cautionary tale for those in Congress looking to blow up the law. Health care is incredibly complex, and it's vital that Congress not rush to pass sweeping reforms simply to satisfy campaign trail promises. Job One is ensuring a smooth transition for people like the Johnsons. Given premium price hikes and insurers leaving the market — the most recent being Humana this past week — short-term fixes must be enacted before grander reforms so that consumers like the Johnsons can continue to afford coverage for 2018 when open enrollment begins next fall.
Consensus on sweeping reforms is still developing in the congressional GOP majority. Proposals from Price and from House Speaker Paul Ryan merit careful consideration, as well as input from health providers, consumer advocates, policy experts and industry. Details are still needed about these proposals so an informed judgment can be made.
But there should be rapid, bipartisan agreement about short-term moves to stabilize the individual market until bigger changes are rolled out. A key problem comes down to basic math. The market is too small (in Minnesota about 5 percent of insurance customers) to affordably spread out the small number of high-cost consumers in this segment.
Insurers recoup costs by hiking premiums. Or, if they can't make money on these policies, they leave. A little-understood problem: Congress exacerbated the problem immensely by weakening federal programs to cushion insurers from financial risks as the ACA's individual market and consumer protection reforms settled out.
Moving rapidly to strengthen and fully fund risk protections for insurers before they set next year's rates is a logical start to stabilize the market. Protecting the ACA's current tax credits is also vital during the transition to a GOP replacement. And, the federal government should consider temporarily funding a national reinsurance program, which could lower individual market premiums by helping offset the cost of high-medical-needs patients.
In addition, Congress should avoid abrupt changes to Medicaid, the public medical assistance program for the needy that expanded in many states under the ACA. Throwing people off the rolls or decreasing funding abruptly would only add to market instability.
The Star Tribune Editorial Board supported the ACA — with reservations. While we do not support repealing, the law does need repairs, and the Republicans have some good ideas on how to do this. In particular, GOP calls to give states more flexibility hold potential. But first, make sure that families like the Johnsons don't go backward on coverage while new reforms are figured out.
