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Avik Roy Proposes an ACA Subsidy Fix Compromise

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Avik Roy, a longtime Republican health policy advisor, sketched out an individual health insurance first-aid proposal at a Senate hearing Tuesday.

Roy suggested that Congress could agree to keep Affordable Care Act cost-sharing reduction subsidy funding in place for 2018 and 2019, and, in exchange, insist on loosening ACA requirements that now increase overall coverage costs.

“It’s appropriate for Congress to consider ways to provide legal certainty for insurers,” Roy said.

But Roy said Congress should combine legal certainty for insurers with help for consumers hurt by ACA-driven increases in individual health coverage premiums.

(Related: Ways & Means Witnesses Attack Group Health Exclusion

Roy, who is now the president of the Austin, Texas-based Foundation for Research on Equal Opportunity, was a senior fellow at the Manhattan Institute. He advised Mitt Romney’s campaign in 2012, and Rick Perry’s campaign in 2016.

He said Congress should:

  • Be tough on the current ACA age band rules, or restrictions on how much plans can charge older enrollees.

  • Ease rules that require most plans to cover at least about 60% of the actuarial value of a standard benefits package.

  • Give states the flexibility to loosen many ACA mandates through the ACA Section 1332 waiver process.

  • Push for replacing the current ACA individual shared responsibility provision, or provision requiring many individuals to own what the government classifies as solid major medical coverage, starting in 2021.

Roy spoke at a hearing on health care costs organized by the Senate Finance Committee, which shares jurisdiction over ACA matters with other Senate committees.

Another witness, Edmund Haislmaier, a senior research fellow at the Heritage Foundation, testified that the current ACA system is helping the working poor, who qualify for ACA premium and cost-sharing reduction subsidies, at the expense of moderate-income people who are having to pay much higher individual premiums, in many states, but do not qualify for ACA subsidies.

If the current system stays in place, many cities will probably have two or three insurers offering exchange plan coverage, but many rural counties will have plans from one Medicaid-oriented carrier, Haislmaier said.

That one Medicaid-oriented carrier may use its monopoly position, and its ability to pass on most of the bills for covering low-income enrollees to the government, to increase the unsubsidized premiums, Haislmaier said. 

— Read PPACA 2.0: New Exchanges v. Reference Pricing on ThinkAdvisor.

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