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June 18, 2019

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Guest Column:

Congresswoman offers prescription for fixing the Affordable Care Act

President Donald Trump said, “Let Obamacare implode,” shortly after the Senate failed to dismantle the Affordable Care Act early Friday morning.

His spiteful words display a complete lack of leadership when it comes to forging a clear path to providing affordable and accessible health care to the American people.

For the past seven years, Republicans have campaigned on repealing the Affordable Care Act. After more than six months of control of both houses of Congress and the White House, they are still unable to come to a consensus on how to allegedly make health care better.

Complex legislation, like Social Security and Medicare, two of the most successful government programs in U.S. history, has to change over time to meet new and unanticipated challenges. I have long said that the Affordable Care Act was not perfect, and I have supported proposals to improve this extremely complicated policy. But it is a mistake to throw the baby out with the bath.

While I am relieved that the Senate’s whirlwind efforts to dismantle the law failed for now, the fight is not over. Now is the time to commit to bipartisan solutions that include committee hearings, floor debates and the voices of constituents.

Anti-ACA rhetoric and bad politics driving the discussion have left such uncertainty in the insurance market that providers are pre-emptively pulling out of exchanges, and rates are going up. This will only get worse unless Republicans include their Democrat colleagues and our governors from both parties in the health care reform debate. By working together, we can provide affordable, high-quality care for all Americans.

Here are five ways we can improve the current law:

Repeal the ‘Cadillac tax’

and medical device tax

Since the 2009 debate over Obamacare, I have opposed the so-called “Cadillac tax” — a 40 percent tax on employer-based health insurance benefits which was not included in the original House version of the ACA. This tax will adversely impact working and middle-class families, including firefighters, ironworkers and police officers. People whose employers provide good health care policies should not be taxed on such a benefit, which has often been negotiated in lieu of salary increases. That’s punishing people for doing the right thing. Unpopular with both Democrats and Republicans, implementation of the tax has already been delayed until 2020 with bipartisan support. So the groundwork has been laid to move forward with this reform.

Repealing the medical device tax is another bipartisan step we could take to make health care more affordable. Implementation of the 2.3 percent tax on certain medical devices, paid by manufacturers and importers, was also delayed until the end of this year. Repealing the tax would promote growth of well-paying jobs and innovation in the health technology industry, and bring down costs of devices like pacemakers, artificial joints, ultrasound machines and glucose monitors for patients.

Lowering drug prices

Americans can agree that affordable prescription drug coverage is a critical component of high-quality health care. A mother should not have to choose between a $600 EpiPen for her child’s asthma or paying two weeks of rent on her family’s small Las Vegas apartment.

It’s time we take another look at how federal dollars are being spent within the pharmaceutical industry and find sensible ways to save that will not affect access to high-quality care. Medicare should be able to negotiate drug prices directly with manufacturers, similar to the Department of Veterans Affairs. We should also promote innovation by encouraging access to more affordable generic prescription drugs. In short, Big Pharma should not be able to hold the American people hostage.

Cost sharing reductions

Cost sharing reduction payments were established by the ACA and have helped millions of Americans afford their out-of-pocket health care costs. The payments help pay premiums and are available to consumers who make between 100 percent and 250 percent of the poverty level. President Trump has refused to commit to funding cost sharing reduction subsidies despite them being required by law. As a result of this uncertainty, the insurance marketplace is unstable, insurers are pulling out of certain areas and consumers — particularly those living in rural areas — are being left without affordable plan options. Guaranteeing that these cost sharing payments will continue is a viable way to ensure stability in markets and prevent skyrocketing premiums. That is why I am a cosponsor of H.R. 3258, the Marketplace Certainty Act, legislation to permanently fund and expand access to these subsidies.


Another one of the ACA’s risk-mitigation programs, reinsurance, allowed insurers to reduce their risk of enrolling high-cost individuals during the ACA’s first two years, helping to stabilize the market and reduce premiums. Insurers who took on high-risk customers received incentive payments from the Department of Health and Human Services that were funded by contributions from insurers and third-party administrators to cover higher-cost enrollees without raising rates for everyone. There is legislation in the Senate to create a permanent reinsurance program for the individual market; and Alaska and Oregon have implemented long-term reinsurance programs. Again, the groundwork has already been put in place.

Medicare expansion

I also support H.R. 676, Rep. John Conyers’ “Medicare for All” legislation, but it will not likely become law in this political climate. Nonetheless, the discussion needs to begin because health care should be a right, not a privilege. Meantime, I support creating an option that would allow those living in counties without an ACA insurance option on the federal exchange to buy into Medicare, regardless of age. Dropping eligibility to age 60 would give those close to retirement age access to an affordable option and help retain solvency of the program by bringing younger people into the risk pool.

Leaving millions without access to affordable and reliable health coverage is not the way forward. So if we truly want to make the health care system better for everyone, let’s start with a bipartisan discussion of these reforms. I am open to other suggestions as well. The American people might not remember who gave them health care, but they will certainly never forget who takes it away.

Rep. Dina Titus, D-Nev., is in her fourth term serving Nevada’s 1st Congressional District.

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