Republicans Won’t Repeal ObamaCare

But the ACA does need reform, as even Democrats recognize because they keep raising subsidies as its policies become unaffordable

WSJ editorial. Excerpt:

"Now costs are ballooning. Federal spending on ACA subsidies has soared to $129 billion this year from $58 billion in 2020. The Congressional Budget Office forecasts the Medicaid expansion will cost $1.4 trillion over the next decade, and the ACA subsidies another $1.3 trillion—and that assumes the 2021 boost expires next year.

The law’s Medicaid expansion to healthy low-income adults is straining state budgets, which has prompted many to reduce payments for providers. As a result, sick people on Medicaid struggle to find doctors willing to see them. ObamaCare’s biggest beneficiaries have been insurers because it subsidizes people to buy overpriced products they don’t need.

Here are some discrete reforms that our sources say Republicans are discussing to lower costs and improve care:

• Repeal the law’s medical loss ratio, which requires insurers to spend 80% to 85% of premium dollars on medical claims. This de facto profit cap has reduced the incentive for insurers to control costs and spurred them to raise premiums and acquire pharmacies and provider groups to circumvent the cap, as no less than Elizabeth Warren has pointed out.

• Roll back the Administration’s rules that make it more vulnerable to fraud. A Paragon Health Institute report this summer found that millions of ACA exchange enrollees misreport their incomes and receive more subsidies than they should. Paragon estimated the cost of fraudulent enrollment at between $15 billion and $20 billion this year.

• Expand short-term health plans, which don’t have to provide benefits not all people need, such as pediatric services, maternity care and mental-health treatment. Such plans are much cheaper than the heavily regulated plans on the ACA exchanges.

• Expand access to association health plans to let employers in the same industry or area band together to provide coverage. This would reduce the cost for small employers—say, fast-food franchisees or contractors—of sponsoring plans.

• Shift healthy, lower-income adults from Medicaid to ACA exchanges so states can’t game ObamaCare’s rules to squeeze more money from Washington. This would also improve care for sick Medicaid patients."