Health care fix today could be undone tomorrow

From our Expert Voices conversation on plans for health care reform after Trump's executive order:

Here's what the bipartisan Alexander-Murray bill would do to prevent large marketplace premium hikes on the eve of the 2018 mid-term election:

• Ensure payments that reduce cost sharing for low-income enrollees for the next two years (cut by Trump's executive order)
• Provide needed outreach support to help Americans sign up for coverage for the next two years (previously cut by the Trump administration)
• Facilitate state waivers like Alaska's to provide reinsurance that lowers premiums

Yet, should this deal pass, it could be undone — and then some — by regulations pursuant to the order. Individual-market premiums could spike next fall if unregulated short-term plans could be sold alongside Marketplace plans. They would siphon off young and healthy enrollees.

Increasing premiums further, employers could drive their high-cost employees to the individual marketplace through loosely regulated health reimbursement arrangements. And employer risk-pooling could be frayed by unbounded association health plans that would separate low- from high-risk small employers.

Necessary as it is, the Senate bill cannot improve marketplace stability if the administration remains determined to undercut it.

The bottom line: Congress should block executive actions that raise premiums, especially for people with pre-existing conditions — in this bill or any other legislation.

Other voices in the conversation:

• James Capretta, resident fellow at the American Enterprise Institute and former associate director for health programs at the OMB: Alexander-Murray deal a flawed first attempt at bipartisanship

• John McDonough, professor at the Harvard T.H. Chan School of Public Health and former Senate adviser on health reform: Obamacare is dead. Long live the Affordable Care Act.
• Tevi Troy, CEO of the American Health Policy Institute and former deputy secretary of HHS: Expanding HRAs would bolster individual market
• Christopher Condeluci, principal at CC Law and Policy and former tax and benefits counsel to the Senate Finance Committee: Clearing the air on AHPs