The U.S. House Energy and Commerce Subcommittee on Health convened a hearing May 11 to review proposed alternatives to the Affordable Care Act (ACA). Subcommittee members heard from three health policy experts, including CHIR’s own Sabrina Corlette, Avik Roy from the Manhattan Institute, and Scott Gottlieb from the American Enterprise Institute.

The hearing in many ways continues a debate that has been repeated ad nauseam over the last several years, with Republican members raising a litany of complaints about the ACA and Democrats on the committee highlighting the law’s numerous accomplishments. However, the tone was more civil than many past hearings, with a number of members expressing interest in moving past the rancor and identifying areas of potential common ground.

That said, the policy proposals floated to build on and improve the ACA could hardly be further apart. Conservative members argued that most of the regulatory standards for health plans set by the law need to be repealed, including protections such as the law’s essential benefits, age rating rules, and minimum standards for actuarial value. Conversely, the committee’s Democrats pointed to those standards as core consumer protections, and some argued the law should be strengthened to include a public option plan and additional federal oversight

Our own Sabrina Corlette highlighted the ACA’s significant accomplishments – reducing the percentage of uninsured to the lowest level in a generation, eliminating pre-existing condition discrimination, and improving the quality of coverage. But she also noted areas in which the law should be strengthened. Her recommendations include:

• Provide incentives to states to expand Medicaid. In 19 states, families just below the poverty line are often denied access to coverage because they do not make enough money to be eligible for marketplace tax credits. Congress should adopt the President’s proposal to allow any state that expands Medicaid to receive a 100 percent match for the first three years.
• Fix the family glitch. Congress should clarify the law to ensure that working families are able to access the marketplace tax credits. Doing so could help ensure that 4.7 million Americans have access to affordable coverage.
• Improve affordability. Even with the ACA’s premium tax credits and cost-sharing reductions, many low- and moderate-income Americans face very high costs when they purchase insurance. For some, given their incomes, the marketplace subsidies are not sufficient to prompt them to enroll or to maintain coverage. Congress should consider proposals from the Urban Institute and others to reduce the amount of income families are expected to contribute to premiums, and to improve cost-sharing support.
• Support outreach and enrollment assistance. As many as 16 million Americans are eligible for but not enrolled in either Medicaid or subsidized marketplace insurance. Many lack information about the availability of coverage options and financial help and need assistance with the eligibility and enrollment process. Congress should allocate funds to ensure that more people are enrolled in the coverage that’s right for them.
• Make the plan shopping experience as easy as possible. The marketplaces need a stronger infrastructure to support eligibility determinations and the plan shopping experience. This should include improved call centers and appeals processes, as well as better web-based tools to support informed decision-making.

It remains to be seen whether this Committee or other members of Congress can find common ground on ways to improve and strengthen the ACA. But on May 11, members heard concrete policy ideas from across the ideological spectrum, and that’s not a bad place to start.