Feinstein: Health care reform will work if Trump abandons 'sabotage'

By Dianne Feinstein

Aug. 10, 2017 11:15 AM PT

When our founding fathers created the Senate, they envisioned a deliberative legislative body that would resist the political pressures of the moment.

Unfortunately, Republican leaders tossed that wisdom aside in their eagerness to repeal the Affordable Care Act. They crafted each iteration of their disastrous bill in secret, without a single public hearing to allow doctors, hospitals, patient groups, or health plans, let alone senators, to weigh in.

The first bill would have taken health coverage away from 24 million and slashed Medicaid by $772 billion. The second bill would have cost 22 million their coverage and cut $756 billion from Medicaid.

The third bill would have caused 32 million to lose coverage. And the fourth bill would have caused premiums to increase by 20 percent and 16 million Americans to lose coverage next year alone.

The legislative process rarely piques the interest of such broad swaths of the American public, but in this case the opaque process was inextricably linked to the dangerous policies that emerged from the office of Senate Majority Leader Mitch McConnell.

Four failed bills and scathing reports from the Congressional Budget Office should finally convince Republicans to take the lock off of one-party control of health care. The fact that the health committee in September will hold hearings on stabilizing the individual market is a good sign that the fever has broken.

During my years in the Senate, I’ve seen the process work the way it should. Although it’s messy and senators never get 100 percent of what they want, the bills that result move our country forward.

Consider the immigration reform bill the Senate passed in 2013. The Judiciary Committee held hearings from February to May. Witnesses ran the gamut, from federal agencies, immigrant rights groups and academics to private industry, legal experts and unions.

Even opponents of comprehensive immigration reform had a say. During the four-day markup, 300 amendments were considered and more than 136 were incorporated into the legislation.

Sens. Marco Rubio, Michael Bennet, Orrin Hatch and I crafted the provisions of the bill that dealt with agricultural workers. We met for many hours over many days, speaking with farmworkers, farmers, growers and agricultural groups. This bipartisan process led to an agreement that was included without changes in the final bill, which ultimately passed the Senate with 68 votes.

That’s the example we need to follow on health care, particularly given that there is agreement on areas to address — affordability in the individual market being chief among them.

Before we can address this issue, President Donald Trump must abandon his efforts to sabotage the market by threatening to stop reimbursing insurance companies for reducing co-pays for low-income enrollees.

In California, the Affordable Care Act is working well. Eighty-two percent of consumers will have at least three plans to choose from and those who pick the lowest-cost silver plan will see premiums increase by just 3 percent.

But if the president follows through on his threats, premiums in California will spike by an additional 12.5 percent.

If President Trump commits to making these cost-sharing reduction payments, Congress could then step in to develop proactive solutions to strengthen the individual market.

One idea is to fix the steep cut-off for tax-credit subsidies in the individual market. Under current law, those making just one dollar more than 400 percent of the federal poverty level — $47,520 for an individual and $80,640 for a family of three—receive no financial help at all.

This means that a 60-year-old making $50,000 spends up to $900 per month on premiums. That’s clearly unaffordable at more than 20 percent of income.

We have a bill to eliminate this fall-off by ensuring that no one in the individual market pays more than 9.69 percent of their income on monthly premiums.

This proposal would increase the cost of federal subsidies by just 1 percent, while motivating healthier individuals who may have opted to go without insurance to get covered. The Commonwealth Fund estimates that 1.2 million people would sign up — 96 percent of whom would be ages 50 to 64.

Increasing the number of relatively healthy, low-cost individuals in the market would in turn help tamp down premium increases. By attracting healthier people to the market and lowering premiums, the federal government would spend $2.6 billion less on subsidies for those who already receive them.

We now know that such a closed process on a major issue like health care doesn’t work. The only path forward is a transparent process that allows every senator to bring their ideas to the table.

Feinstein is a U.S. senator from California.