BPC Future of Health Care: Bipartisan Policies and Recommendations

BPC’s approach includes two stages:

  • To provide near-term relief and help secure bipartisan compromise and trust, BPC’s Future of Health Care leaders have proposed five policies to immediately stabilize health insurance premiums; promote choice, and competition in the individual health insurance market; explore policies to promote greater insurance enrollment with less reliance on the “individual mandate;” and enhance flexibility for states to implement innovative solutions for their residents. Any costs associated with these policies would be fully offset so as not to add to the federal deficit.
  • It is also necessary to move quickly beyond near-term fixes to consider more fundamental changes in health care: to build a strong, bipartisan consensus on its key design features; slow rising costs; promote greater enrollment in health insurance; and improve the quality of care delivered to patients. The group has identified some key areas where ongoing legislative changes should be made to make health care in America more affordable, accessible, reliable, and sustainable over the long-term, all the while retaining adequate incentives for innovation.

Stage one recommendations:

1. Provide health insurance cost-sharing subsidy reduction funding for at least Plan Year 2018 immediately, and for Plan Year 2019 by the end of March 2018; 

2. Establish a Health Insurance Stability Fund that would award states funds that could be used for reinsurance, invisible risk pools or other mechanisms to address risk and lower premiums; 

3. Give enhanced flexibility for states to implement innovative solutions for their residents through expedited approvals of State Innovation Waivers, also known as 1332 waivers, by shortening the application review time from 180 days to 90 days;  

4. Allow greater use of Health Savings Accounts (HSAs) for consumers to cover their deductibles by temporary increasing the HSA annual contribution limits for self-only and family coverage to match the out-of-pocket limits for HSA-qualified High Deductible Health Plans for the same groups; 

5. Develop alternatives (via the Department of Health and Human Services and Internal Revenue Service) to the individual mandate that do not have detrimental impacts on market stability and affordability.These would be developed over time as a state option and include automatic enrollment policies to promote greater i

BPC’s Future of Health Care leaders have highlighted potential policies that Congress could enact (in any combination) to fully offset the budgetary cost of the near-term policies discussed in this proposal.  These may be found on pages 6-7 of the proposal.

Stage two includes (at minimum) exploring policies that would: address the opioid epidemic, modify the Affordable Care Act’s “Employer Mandate,” allow for additional state flexibility in financing and providing coverage to low-income populations, address prescription drug costs, promote the implementation of value-based insurance design and the use of HSAs within the context of consumer-directed health plan designs, and accelerate the movement toward value-based provider payments, quality improvement, provider risk-sharing for the cost of patients’ care, and other innovations to advance responsible cost containment across all federal health insurance programs.  

BPC’s Future of Health Care leaders are committed to reaching agreement on a set of broader reforms by the end of this year, with the aspiration they could be advanced as soon as possible in the 115th Congress.