Americans continue to hear a lot of rhetoric — but not enough solutions — coming out of Washington about health care.
In an op-ed in the News Journal last month, I explained that I opposed the first version of the Senate Trumpcare bill because it would have forced tens of millions of Americans off of their insurance and lowered the quality of coverage for many millions more — all to pay for a tax cut for the wealthiest Americans. The “revised” versions weren’t any better, which is why early Friday morning the Senate Trumpcare bill failed, with opposition from both Republicans and Democrats.
My opposition to these bills, though, was not rooted in partisanship. As I’ve been saying for years, the Affordable Care Act (ACA) isn’t perfect.
Small businesses that want to offer health insurance for their employees have struggled to find affordable options. Some deductibles or premiums are higher than folks would like, in part because of a lack of competition in the market.
I’ve also heard from economists and budget forecasters who know our fiscal health depends on doing even more to control rising health care costs.
Instead of continuing the partisan back-and-forth that won’t get us anywhere, I’d like to outline a series of revisions to the Affordable Care Act that will give individuals and small businesses greater access to more affordable, more accessible, and higher-quality care. Many of these ideas already have bipartisan support in Congress.
The first question we need to address is why insurance hasn’t been as affordable for many individuals as we’d hoped. A lack of competition in the marketplace (which particularly affects smaller states like Delaware) and a climate of uncertainty surrounding the future of the ACA are both to blame.
To help bring prices down, I’m a cosponsor of a bill led by Delaware’s senior Senator, Tom Carper, and our colleague, Sen. Tim Kaine of Virginia. This bill, the Individual Health Insurance Marketplace Improvement Act, would create a permanent reinsurance program for the individual health insurance market, bringing more certainty to the marketplace.
That translates into lower premiums for consumers. It’s similar to the successful program used to lower premiums and spur competition in the Medicare Part D program.
We also have to make the Affordable Care Act work better for small businesses. Last year, I introduced the Small Business Tax Credit Accessibility Act to expand and simplify the ACA’s small business tax credit. The bill would have made the credit available to more employers for a longer period of time.
I’ve also been proud to cosponsor a bipartisan bill in the Senate that would direct the Treasury Department to make the small business reporting requirements more workable and less burdensome for employers.
In the coming weeks, I’ll introduce a bill that would incentivize insurance companies to stay in states with only one dominant insurer (such as Delaware) and encourage other insurers to come into the marketplace and provide more competition. I recently held a Facebook town hall and heard from many constituents who want to see more competition in Delaware’s health insurance marketplace. This proposal would be an important step toward that goal.
More generally, Congress should also look at ways to make the ACA’s tax credits more generous so that more families are eligible and aren’t caught in a situation where they make too much to qualify for tax credits but not enough to afford comprehensive health insurance.
We need to take a broader look at what’s driving up health care costs in the United States. Why, exactly, is health care so expensive here?
There’s no reason that the same procedure should cost $500 at one hospital but $5,000 at another. We have to take a serious look at the costs of prescription drugs and make sure that some bad actors aren’t engaged in price gouging.
We have to reform our health care system to make sure that costs are directly tied to the value of the service, rather than the number of procedures. No matter how perfect a health insurance system appears on paper, if costs are still going up, we haven’t yet found the solution.
For those who don’t believe Republicans and Democrats are capable of working together to improve the Affordable Care Act, I have proof that it can be done.
In 2011, in the face of opposition from the administration, numerous advocacy groups, and even some of our colleagues in Congress, I worked with Sen. Carper, Republican Sens. Pat Toomey of Pennsylvania and Marco Rubio of Florida, and our colleagues in the House (including Delaware’s now-Governor John Carney) to write, pass, and get signed into law a revision to the ACA to clarify how the law applies to expatriate health insurance plans.
This bipartisan fix made sure that U.S.-based expatriate insurance carriers can compete on a level playing field with their foreign competitors and that American jobs stay here in the United States. This law saved 500 jobs in Delaware alone.
Crafting a health care system that works for all Americans is no easy task. But the Affordable Care Act provides a solid foundation from which Republicans and Democrats should be able to find common ground. The ideas I’ve outlined offer a great place to start.
Neither party has a monopoly on good ideas. Let’s find constructive ways to expand coverage and lower costs. Let’s make health care coverage more affordable by making subsidies for middle-income families more generous.
Let’s simplify and increase the small business tax credit under the ACA. Let’s increase marketplace competition, especially in small states like Delaware. Let’s make common sense regulatory reforms and cost containment efforts to further slow the growth in health care costs.
On each of these areas, I’m going to keep looking for Republican partners willing to sit down at the negotiating table and get to work on improving the Affordable Care Act. As my friend John McCain urged in a moving speech on the Senate floor on Tuesday, let’s come together with ideas from both sides.
Let’s hold hearings and have a real debate on the Senate floor. If we do, as Senator McCain said, we’ll find our way to “pass something that will be imperfect, full of compromises, and not very pleasing to implacable partisans on either side, but that might provide workable solutions to problems Americans are struggling with today.”
Senator McCain is, once again, exactly right.