What will it take to fix ACA?

stethoscopeWhen President Obama back in 2010 said of the flawed Affordable Care Act, pass it now, fix it later, perhaps he never dreamed of the extent to which politics would have paralyzed the U.S. Congress.  In the past, with major laws like Medicare and Social Security, legislators took an engineering model approach. Pass it. Test it. Learn from real world experience. Tinker and readjust it to make it work better. Bipartisan majorities, acting in good faith,  came together  to move the process forward.

Sadly, in the current toxic partisan environment, making any fix will be difficult if not impossible. Too many want to repeal ACA rather than repair it.

The enrollment website, which had a disastrous roll-out at both the federal and state level, will be fixed.  Don’t laugh. That’s the easy part. There are other things that need attention, but won’t be improved as easily.  Congressman Steve Lynch spelled out a few of those today in this morning’s meeting with The New England Council.

I asked Lynch if he were empowered to make things happen, what would he do?  The sole Democrat to vote against the final version of the Affordable Care Act, Lynch would change three things. First, he’d alter  the strategy of what he calls “taxing our way” to an affordable health care system.  In 2018, American business will take a big hit, when a 40 percent tax is imposed on so-called Cadillac plans, those that exceed a government cap on premium cost.  This, he warned, will “drive up costs of doing business in the United States dramatically,” making us less competitive, and by then, he observed , “the current administration will be gone.”  “I sort of think that’s how they scheduled it,” he smiled.  (A mild version of the House of Cards playbook or more kick-the-can down the road business as usual?)

Lynch also would change the “cartel status” given to insurance companies by exempting them (as had happened years ago with Major League Baseball) from anti-trust regulations. At least one health insurer in the room sat stony-faced as Lynch explained that existing incentives in the health care law not to act in restraint of trade simply don’t work.

Lynch would also introduce competition by including a public option at the state or regional level.  If, for example, Massachusetts and Connecticut unified their systems to offer a public alternative, they’d be able to negotiate from a position of strength with providers, insurers and suppliers, which could actually lower cost.  Long-term, all the New England states could work collaboratively for bargaining power to lower costs. He’s not being a dog in the manger. He had supported an earlier House version of ACA that included a public option.

Lynch has always been a voice of moderation in the Massachusetts delegation, refusing to march in lock-step with members if he disagreed on a particular issue.  It has often earned him criticism from those to the left of center. Don’t ever look for the Boston Globe to endorse him.  In fact, in endorsing Cong. Ed Markey in last year’s special U.S. Senate race, the paper specifically cited Lynch’s vote against ACA in weighing its decision. But I’ve always found him thoughtful, with a great deal to add to public debate. We’ll definitely be talking about the issues he raised today in coming months and years. We shouldn’t be afraid to consider Lynch’s perspectives in weighing where we should go from here.

I welcome your thoughts in the comment section below.

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