Bipartisan fever: Conservative and liberal experts offer Congress a plan to reform ACA

Nine prominent conservative, centrist and progressive health policy experts have called on Congress to take bipartisan steps forward on healthcare reform, proposing a framework to stabilize and reform the Affordable Care Act's insurance market.

The experts' proposal included compromise on both sides. Conservatives in the group, who have strongly opposed the ACA, agreed to shore up pillars of the law. They backed funding the cost-sharing reduction payments to insurers that President Donald Trump is threatening to end; establishing reinsurance mechanisms to protect insurers that sign up sicker enrollees; strengthening enrollment education and outreach; and creating strong incentives for people to maintain continuous coverage.

For their part, the progressives, who want to keep the law's federal consumer protections, supported giving states more flexibility to develop their own systems for providing coverage to low- and moderate-income people. That could include letting states combine federal payments for Medicaid, private exchange plans and the Children's Health Insurance Program to create seamless coverage arrangements.

The group, which came together through the Convergence Center for Policy Resolution, urged Congress to take bipartisan action by the end of September to stabilize the individual insurance market until a longer-term resolution can be achieved and to protect healthcare access and coverage.

The consensus statement comes as bipartisan groups in both the House and Senate have emerged to discuss measures to steady the market, following the collapse last month of the GOP-only effort to repeal and replace the ACA.

But even one of the members of the bipartisan expert group expressed doubts about whether congressional leaders of either party would listen. "Right now the biggest hurdle is how to move legislation that doesn't have leadership pushing it," said Gail Wilensky, a senior fellow at Project HOPE who headed the Medicare agency in the George H.W. Bush administration. "I don't know that you can."

The signers of the new reform framework include Joe Antos, a resident scholar at the conservative-leaning American Enterprise Institute; Stuart Butler, a senior fellow at the Brookings Institution and former vice president at the Heritage Foundation; Lanhee Chen, a research fellow at the conservative Hoover Institution; John McDonough, a public health professor at Harvard who helped draft the ACA; Ron Pollack, chair emeritus of Families USA, who helped build support for passage of the ACA; Sara Rosenbaum, a health law professor at George Washington University who's a strong advocate for protecting Medicaid; Grace-Marie Turner, president of the conservative Galen Institute; Vikki Wachino, former CMS Medicaid director in the Obama administration; and Wilensky.

"It's a serious effort to show that people who aren't just centrists could hammer out agreement," Wilensky said.

There is growing Republican support for at least temporarily funding the cost-sharing reduction payments to insurers, without which premiums likely will spike and more carriers will exit the market. There's also some GOP backing for re-establishing reinsurance programs to persuade insurers to stay in.

But there are broad doubts about whether Republicans and Democrats can agree on GOP demands to ease the ACA insurance market rules as a way to offer lower-priced health plans.

The bipartisan expert group cautiously endorsed some easing of these market rules. It said Congress should modify the ACA's Section 1332 waiver program to allow states greater flexibility in using federal subsidy payments.

Republicans want to relax the four so-called guardrails in the ACA for ensuring that the alternative systems states establish provide the same level of coverage and benefits as offered by the ACA's exchanges and subsidies. Democrats are wary because they fear some states would set up systems covering fewer people with skimpier benefits.

The members of the bipartisan group acknowledged that they differed on the scope of the guardrails that should be established. But, they wrote, "we encourage Congress to consult with states and others on how to refine the guardrails to provide enhanced flexibility." The goal, they said, is to "promote continuity, health care efficiency, and coverage innovation."