Op-ed: Giving states flexibility in Obamacare aftermath of King v. Burwell
The average 27-year-old Illinois man who purchased health coverage on the federal Affordable Care Act (ACA) exchange in 2013 has spent the past year helplessly watching the cost of his premium double. In the next few months, a Supreme Court decision could leave exchange enrollees in Illinois wishing a 94 percent cost increase was all they got.
The Obama administration’s one-size-fits-all approach to health care is failing Americans. The president still isn’t buying into the proof that the best solutions come from local empowerment and state leaders who have a vested interest in doing what’s best for their communities.
Last summer I organized a health care forum in my congressional district. I listened to insurers, employers, patients, and caregivers talk about their biggest challenges and ways we can make our entire health system work better for the people it is supposed to serve. From these conversations grew a new, locally informed approach to health care: Empower states.
The newest Affordable Care Act (ACA) exchange enrollment figure stands at 11 million. This group of insured Americans – only about 40 percent of whom were previously uninsured – now wobbles on a legal fault line that could split it in half. The Supreme Court began hearing oral arguments in the King v. Burwell case on March 4. Should the Court rule this summer that federal exchange plans are not eligible for subsides, more than six million Americans in 37 states could lose their insurance or, at least, their ability to afford it.
For these Americans – and the millions of others facing higher premiums, higher out-of-pocket costs, and smaller networks – there is, as of yet, no way out.
Could state ACA waivers be the answer?
To date, the Obama administration has only paid lip service to a state ACA waiver process so treacherous to navigate that states dare not apply. The Centers for Medicaid and Medicare Services (CMS) quietly announced their 2011 proposed waiver rules just two months after the inauguration of a new Congress, and the opaque guidelines elicited only 27 public comments. To apply for a waiver, states are first required to pass the pertinent legislation, then create a 10-year, revenue-neutral budget plan, and then produce exhaustive state resident data including age, income, health expenses, and health insurance status. Even if state applicants were successful, CMS required them to wait until 2017 before a waiver could take effect. This set of Herculean tasks made it functionally impossible for states to take care of their own residents through smart, local innovation.
My district forum confirmed my belief in bottom-up solutions to our nation’s problems, especially when it comes to something as personal as health care. The ACA blankets the entire country with one-size-fits-all mandates, and it offers states no flexibility to cater to their unique populations or maximize scarce resources. What works for a single mother struggling to raise her children in Wisconsin probably won’t work for an employer in California.
This diversity has driven me to find out what works for Illinois.
In the coming weeks I plan to introduce a bill establishing a clear and workable health-flex waiver process that empowers states to experiment outside ACA parameters. My plan would give states flexibility to administer federal health programs and offer consumers more plan and provider options outside confirmed markets and cramped networks. If the Supreme Court strikes down the ACA subsidies, this framework would step in to address the confusing and disruptive aftermath. My plan would give affected states individual allotments to “catch” the truly needy and continue providing them with financial assistance.
My state health-flex waiver proposal strikes the existing inflexible waiver regulations, returns administrative authority to the states, and offers them three feasible choices:
1) Remain in the ACA system.
2) Apply for an ACA waiver that would allow approved states to self-administer federal insurance programs and regulate their respective insurance markets on their own terms.
3) Completely opt out of the ACA.
Conservatives have floated reform proposals that could serve as springboards for states interested in trying on more suitable health care alternatives for size. The health-flex waiver is critical to the success of a comprehensive, free-market solution. Under my proposal, states will be rightfully returned to the driver’s seat, positioning them to build a health care system that will best benefit their own citizens.
The ACA’s foundation is crumbling, and the Obama administration is out of quick fixes. States have independently produced and tested successful approaches to countless national problems – let’s give them health-flex waivers and pave the way to better health access and affordability for all.
Hultgren has represented Illinois’ 14th Congressional District since 2011. He sits on the Financial Services and the Science, Space and Technology committees.