political bluster, it would be prudent
for lawmakers to consider what the
ACA’s aims were and figure out how to
continue to support its successes while
making adjustments to overcome some
of the challenges that have arisen. Here
are some of the key features of the ACA
and why they need to be understood before any replacement plan can be drafted.
1Guaranteed Issue The ACA aimed to get more Americans health care coverage and to reduce the cost of health care for the nation.
Obviously, ensuring that all individuals qualify for coverage goes
a long way toward achieving the first part of that goal—hence
the guaranteed issue requirement of the ACA. This requirement
means that anyone who applies for coverage is issued a policy.
That is, no one can be denied for coverage due to pre-existing
conditions. One of the main impacts of this feature is that a portion of uninsured people who simply could not find coverage
before can now obtain health care coverage. Another impact
is that ACA plans now cover previously uninsured people with
high-cost conditions and subsequently experience very high
Any ACA replacement needs to take a hard look at this guar-
anteed issue requirement. Does the federal government still
believe it should support access to coverage for Americans? Is
anything short of guaranteeing issuance acceptable? What is the
best way to handle people with (high-cost) pre-existing condi-
tions? Removing this guaranteed issue requirement would likely
have the impact that people who are currently covered will no
longer have health insurance. This is a major ramification that
needs to be thought through seriously. If the goal of the federal
government in regard to health care is still to expand cover-
age to more Americans and make health care more affordable,
simply removing the guaranteed issue requirement would not
achieve that goal.
One idea that gets discussed is setting up high-cost risk pools
for individuals with certain costly conditions. This would not
entail anyone losing coverage and it would lower the costs for
ACA plans, but the problem is that these high-cost individuals would not have any subsidization from healthier insureds.
Generally, health care plans charge a premium for all the lives
on that plan. Some people pay a little more than they end up
using in benefits, some people pay less than the benefits they
end up using. In total, though, everyone pays some so no one
has to pay a lot (that’s the idea anyway). If high-cost lives were
moved to a separate plan, the costs of health care for those on
ACA plans would likely decrease, but the costs for these high-risk individuals would then increase. Maybe this is the solution
the federal government is looking for, but the question needs
to be posed whether this really achieves the ACA goal of reducing health care costs for everyone. There are certainly ways
to work through this—possibly a government subsidization of
these high-risk pools—but this is a complex law, and any replacement needs to be fully vetted, which includes accounting
for the points of view of all parties.
provisions into account