Separate reports released Tuesday offered differing strategic advice and policy recommendations for lawmakers grappling with the repeal and replacement of the Affordable Care Act.
A new report by The Committee for a Responsible Federal Budget says any repeal-and-replace legislation should embody three basic principles: Reduce the national debt, replace or strengthen the health care law’s cost-control measures, and maintain or improve Medicare solvency.
A similar report by the Urban Institute urged lawmakers to address complaints and correct problems with the health law through legislative fixes rather than the disruptive process of repealing and replacing the law.
If Congress adopts a “repeal and delay” proposal that sets dates for terminating the law’s coverage provisions, the committee says, the bill should include three additional core components: Continue the law’s revenue-generating provisions as long as coverage provisions are retained, make sure the savings from repeal can finance any replacement and ensure the law’s replacement is done in a timely and fiscally responsible manner.
“With the national debt at post-WWII era record-high levels and growing unsustainably, it is important that changes to the ACA be fiscally responsible,” the committee analysis said.
In the Urban Institute report, “Given the possibility of insurance market chaos during the period between repeal and effective replacement and the unavoidable challenges of implementing a new set of reforms, policymakers should ask whether correcting the flaws in the ACA might sufficiently address critics’ major concerns,” institute researchers John Holahan and Linda Blumberg wrote.
The institute’s plan features a package of revisions to address issues related to coverage affordability, variations in premium rates based on age, mandatory benefits requirements, the individual and employer mandates, and the so-called “Cadillac” excise tax on high-cost health plans.
It calls for replacing the law’s penalties for violating the individual mandate, which requires almost everyone to carry health insurance, with a modified version of the late enrollment penalties used in the Medicare Part B and Part D programs.
Institute researchers recommend abolishing the employer mandate, which requires certain employers to provide health coverage for their workers or face a penalty.
“The limited gains in coverage and the revenue it generates have not been worth the controversy it has caused,” Holahan and Blumberg wrote .
The authors advise replacing the law’s Cadillac tax with a cap on the tax exclusion for employer health insurance contributions.
They also call for stabilizing the insurance marketplace by increasing premium tax credits and cost-sharing assistance for those with modest incomes and capping premiums for those with higher incomes at 8.5 percent of annual income.