President Obama made his rounds at Democratic campaign functions to remind voters of the importance their decision would have on the maintenance of his presidential legacy. Unequivocally atop his most notorious actions as president is his implementation of the Affordable Care Act, which passed in 2010. Although the oft-maligned, yet vehemently defended program has enjoyed the political cover that comes during the final days of mudslinging between opposing presidential campaign camps, Americans were simultaneously hit with disturbing shifts to their health insurance plans as they made their way to the polls.
One of the latest announcements impacting Obamacare enrollees came just days before polls opened around the country. Bloomberg’s headline read, “Obamacare Benchmark Premiums to Rise 25% in Sharpest Jump Yet,” with some areas of the country suffering more than others. In Nashville, TN, a mecca for the healthcare industry, premiums rose by an average of 54%, almost double the national average. For the Volunteer State, this comes on the heels of Blue Cross Blue Shield’s infamous exit from the exchange market, a move by the state’s largest insurer that “sent shockwaves” across the region—particularly because it was preceded by the August announcement by the state’s insurance commissioner that the Obamacare exchange is “very near collapse.”
Watch On Forbes: Under President Trump, Repealing Replacing Obamacare Will Be Harder Than It Looks
Unfortunately, this is reverberating across the nation. Rather than wait for the environment in Washington to change, state policymakers owe their citizens diligence in finding ways to maneuver amidst the federal government’s red tape. We should build foundations for a new infrastructure—one that relies on the states, not the feds, to take the lead in delivering on the unmet Obamacare promises of healthcare access, choice and affordability. Here’s how we can start:
1. Lawmakers should conduct a full audit of federal, state and local governments’ efforts to address healthcare.
This inventory and analysis should identify each program’s target population, assess how much of the taxpayers’ funds directly benefit the intended recipients, and find gaps in healthcare access. This process should also include steps to eliminate ineffective, inefficient and duplicative programs, and redirect resources to better meet the needs of the poor and vulnerable.
2. Those states that did take legislative action on at least one of the ACA’s insurance market reforms should repeal those provisions.
The ACA took away much of states’ authority over insurance regulation in individual health insurance markets. That is why states should evaluate the steps they took to comply with and implement the ACA.
States should then create a plan of action to repeal or modify those laws in order to have more autonomy over their insurance markets should federal control over insurance be returned back to the states.
3. States should implement a robust and timely verification system that verifies, in real-time, eligibility for Medicaid and other welfare programs.
When Illinois lawmakers implemented their SMART Act (Save Medicaid Access and Resources Together) in 2012, they systematically audited their Medicaid program and discovered more than 8,000 dead people were receiving Medicaid benefits and 300,000 no longer met the requirements for Medicaid eligibility. Other states should look to Illinois as an example of how to audit their own Medicaid programs and put processes in place to ensure Medicaid rolls don’t swell unnecessarily.
4. States that expanded Medicaid under the ACA should immediately seek new, innovative ways of assisting able-bodied adults living above poverty through the private health insurance market. States should also seek permission from HHS to freeze new Medicaid enrollments for these able-bodied adults. If HHS is unwilling to grant this freeze, states should seek to roll back program eligibility to pre-ACA levels.
In doing so, states should also urge Congress to allow them to freeze eligibility through the state plan amendment process. This would be particularly helpful to states should there be a change in either the federal funding formula for the expansion population or any limits on provider assessments.
5. States should remove barriers that artificially limit patients’ access to healthcare facilities, procedures and providers.
For example, rolling back scope-of-practice laws can help alleviate the shortage of healthcare providers, especially in rural areas. Healthcare practitioners should be allowed to practice at the top of their education and training.
6. Certificate of need (CON) laws consistently restrict competition. States with CON laws should repeal them to expand access to quality care.
Thirty-six states continued to impose CON regulations before the 2016 legislative sessions. Tennessee, ranked the seventh most restrictive in the nation, repealed approximately half of these antiquated laws—regulations that had previously resulted in 8,500 fewer hospital beds and 32 fewer hospitals offering MRI services. Those lawmakers looking to make similar strides in their states should take notes from the legislation passed in Tennessee.
7. Lawmakers should protect and empower healthcare innovators, especially when they offer consumers an affordable option to access timely care.
This is an increasingly important point, as the ACA is dramatically increasing the cost of accessing healthcare for many patients through higher premiums, deductibles and co-pays. No one believes that innovations such as telemedicine should substitute completely for a long-term relationship with a primary care provider. But consumers should have the option to seek affordable and timely care when they so choose.