Anniversary of Affordable Care Act Brings Calls for Insurance Reforms

WASHINGTON — President Joe Biden visited Ohio Tuesday to promote his economic stimulus program while Congress took steps to move the health insurance part of it into new territory.

The Biden administration’s $1.9 trillion American Rescue Plan expands subsidies to make health insurance more affordable for millions of people.

The subsidies continue a modified version of the Obama administration’s Affordable Care Act, which reached its 11th anniversary Tuesday.

The Affordable Care Act represented the U.S. healthcare system’s most significant regulatory overhaul and expansion of coverage since Congress approved Medicare and Medicaid in 1965.

In its original form, it required all American taxpayers to purchase health insurance or face an income tax penalty. It also sharply reduced the authority of insurers to reject customers, even if they had preexisting or costly health conditions.

President Donald Trump repealed the requirement of purchasing insurance, also known as the individual mandate. Other provisions of the Affordable Care Act remain in effect.

It extended health insurance to as many as 24 million Americans who otherwise could not afford or obtain it.

Now, 18 bills are pending in Congress that would put slightly different spins on how the health insurance subsidies would be spent, who is eligible for them and new regulations for health insurers.

They were the subject of a House Energy and Commerce Committee hearing Tuesday where Democrats advocated expanding the insurance coverage but Republicans preferred cutting health care costs instead.

One of the compelling stories during the hearing came from Laura Brun Hatcher, the mother of a now 14-year-old disabled son named Simon whose complex health care needs would not have been possible without the Affordable Care Act.

His severe neurological birth defects would have destroyed the family’s finances or killed their son, she told lawmakers.

Their livelihoods were jeopardized again by Republican efforts during the Trump administration to eliminate the Affordable Care Act but restored by the American Rescue Plan.

As Brun Hatcher thanked the lawmakers, she said in her testimony, “You voted to support funding for Medicaid, for Home and Community Based Services that people with disabilities like my son need to stay in their communities and out of deadly institutions. You voted to encourage states that have not yet expanded Medicaid to do so, so more people like Simon can access the life-saving care they need.”

Some Republicans said that for all the stories of how the Affordable Care Act subsidies saved some people, they also drove up health care costs and drained tax resources needed for other programs.

“The bills [pending in Congress] today continue us down the path of socialized medicine that President Obama started,” said Rep. Cathy McMorris Rodgers, R-Wash.

Rep. Brett Guthrie, R-Ky., said the Affordable Care Act has backfired in its efforts to increase options for health care insurance. The program’s restrictions on the authority of insurance carriers to deny coverage for persons with preexisting conditions put too much of a financial burden on them, he said.

“The ACA has increased premiums dramatically and a lot of insurers have ceased coverage,” Guthrie said.

Instead of moving toward socialized medicine, the government should instead “be looking at innovative ways to reduce health care costs,” he said.

One of the pending bills would provide matching grants to states that choose to expand Medicaid coverage. Another would fund state efforts to increase health insurance coverage, such as through automatic enrollment and other streamlined procedures.

A third bill would reduce federal subsidies to states that fail to meet standards for reducing administrative costs of their health insurance programs.

Rep. Frank Pallone, D-N.J., who supports some of the bills to expand or modify the Affordable Care Act, said, “The ACA has worked.”

Despite Republican efforts to get rid of it, “It’s still around,” Pallone said. “It shows its resiliency. It shows how people really want it.”

Marni Jameson Carey, executive director of the nonprofit Association of Independent Doctors, said the value of the U.S. health care system will be challenged until hospitals and other health care providers are compelled to control their costs.

She blamed health care industry consolidations and corporate executives trying to protect their “revenue streams” for part of skyrocketing expenses.

“We have to bring down the whole burden across the board,” Carey said.