Other voices: Republicans need to get serious about health care

When the longest leadership shutdown in U S history ended not long ago Republicans mostly got what they requested A spending bill was passed the regime was reopened and Democrats main demand a deal to extend expiring Obamacare subsidies was deferred Now Republicans must deliver on a healthcare care compromise lest millions of Americans get stuck with big bills come January At issue is the expiration of COVID-era benefits for Affordable Care Act enrollees When the ACA passed in lawmakers included a provision that would help reduce monthly costs subsidized premiums for beneficiaries earning less than of the federal poverty level about at the time During the pandemic Congress increased such assistance and expanded it to higher earners The Inflation Reduction Act extended those changes until Dec Letting the enhanced subsidies expire will be disruptive On average enrollees out-of-pocket premiums will double Older relatively higher earners will be among the hardest hit According to one analysis premiums for a -year-old couple earning would climb by a month or annually While lower earners may see milder increases monthly payments could rise to say from zero experts worry that higher premiums will push healthier people to drop coverage further increasing costs for those who stay enrolled Perhaps million people will become uninsured Neither party wants to see that happen least of all before midterm elections next year Yet extending the subsidies permanently as Democrats wish at billion over a decade is likely a nonstarter Beyond the large sum critics object to the flow of payments which go straight to insurers With taxpayers footing the bill fitness plans have done little to contain costs Consider that premiums on ACA exchanges have risen almost twice as fast as the employer-based sector since A temporary extension as the White House appears to backing would do little to resolve this Ideally any compromise would soften the shock of lost subsidies while slowing the expansion of federal spending The first is best achieved by eliminating the subsidy cutoff at of the poverty line Economists have long disliked benefits cliffs which penalize work and higher pay and the cost of eliminating the threshold would be relatively modest Expenditures per enrollee shrink as incomes rise Lawmakers could offset the additional spending by increasing enrollees share of premiums for the highest earners lowered to of household income during the pandemic while restoring assistance for lower earners to pre-COVID levels Republicans haven t been notably serious about physical condition care in new years but particular reasonable proposals are emerging One would direct funds previously earmarked for insurers into tax-advantaged health-savings accounts Once consumers gain control over their dollars the thinking goes insurers would be forced to compete for their business and lower costs As at the moment envisioned the idea will be complicated to implement before the deadline It s also too narrow applying only to ACA plans with the lowest premiums and highest deductibles But a revised version that ensured funds can be used more liberally would be a step in the right direction Beyond the immediate negotiations lawmakers should be thinking bigger about how to restrain costs Paramount should be giving consumers more choice including those in the much larger employer-sponsored domain Gradually allowing more flexibility to pick a healthcare plan be it short-term coverage or a citizens option should increase competition and improve care without destabilizing the sphere A effort that s easily executed and avoids immediate disruption such as eliminating the cliff might be supplemented with such reforms in the future For now a bipartisan agreement that extends and reforms subsidies would be the right thing for taxpayers and enrollees alike Without a longer-term plan though America s soaring physical condition care costs threaten to become one more situation in the making The Bloomberg Opinion Editorial Board