Members Only How to Fix the Affordable Care Act

If you were trying to purchase health insurance in the individual and family market just four years ago, there was a 22 percent chance you would be denied.

But today the percentage of Americans who can be refused coverage is zero. And the millions of Americans who already had coverage are now better protected.


In fact, this week marks a milestone for the Affordable Care Act, as the end of the first marketplace open enrollment period draws to a close. Millions of Americans have accessed new insurance options on the marketplace, and we urge those who still need health coverage to visit HealthCare.gov to see their options.

As each of us has said from the beginning, the ACA is not perfect. And as each of us has promised, we are taking important steps to make the law work even better for families and small businesses across the country. From repealing the 1099 filing requirement to easing the paperwork burden on small businesses to allowing individuals to “window shop” for their insurance options on HealthCare.gov, we have already eliminated several unnecessary and bureaucratic barriers while maintaining consumer protections that provide invaluable peace of mind to millions of Americans.

But there is more to be done.

That’s why today we are laying out some next steps to further improve implementation and ease the transition not only for individuals and families, but also for small businesses.

First, we want to give consumers as many choices as possible when it comes to selecting their health plans. By providing a new, lower cost, high deductible option called the Copper Plan (in addition to the existing Platinum, Gold, Silver and Bronze-level options in the marketplace) we will give consumers more control over their own coverage, spur competition and, most importantly, increase affordability.

We are calling to restore startup funds for new consumer-driven health insurance cooperatives, now operating in 23 states. This will allow families to have more options to access health coverage beyond traditional insurance companies, infusing state marketplaces with more competition to reduce average premiums.

We also propose directing state insurance regulators to develop models for their states to sell health insurance across state lines. These multi-state models will help us discern the benefits and challenges of selling health insurance in this manner, and determine if it is a means to increasing choice and competition among plans—potentially driving down costs while maintaining quality and value.

Second, to ease the transition for employers, we want to expand the option for voluntary coverage for employers with fewer than 100 employees, about 98 percent of all businesses. This will enable small and mid-sized businesses to make their own choices for their businesses, and employees can shop for coverage on the individual marketplace.

To improve flexibility and increase affordability for our small businesses, we want to make the small business health care tax credits available for a longer period of time and accessible to more employers so that small businesses can spend less time and money worrying about coverage for their employees. Expanding the current tax credits to include businesses with fewer than 50 employees—instead of the current cap at 25 employees—would provide a real benefit to hundreds of thousands of small businesses and allow them to offer quality coverage to recruit and retain talented employees.

We want to reduce the regulatory and administrative burdens for businesses that are required to offer coverage to their employees by making sure reporting requirements are more streamlined. This means simplifying processes for these employers and enabling family members working for the same business to be counted as one full-time employee if they are on the same employer-sponsored health plan.

Finally, we simply want to make it easier for individuals and families to access quality health coverage by offering more than one way for individuals to enroll. We seek to provide a permanent path—in addition to HealthCare.gov—for consumers to seamlessly enroll directly through insurers, while improving access for the agents and brokers whom many families and small businesses trust and rely upon for help with these decisions.

Beyond these proposals, there are more steps to take to help the health care reform law work better for employers and to continue to make sure premiums are affordable for all Americans.

But let’s stop trying to score political points by turning up the rhetoric and instead roll up our sleeves and get to work.

Let us be clear: We are not going back to the days when a child with a pre-existing condition could be denied coverage. When our mothers, sisters and daughters had to pay more for coverage simply for being a woman. When our seniors couldn’t afford the medicines they needed. And we are not going back to the days when Americans’ health and security could be jeopardized by an arbitrary denial of coverage.

We encourage our colleagues from both parties, in the House and the Senate, to join us in this responsible effort to make the Affordable Care Act work better for America’s families and businesses.

The authors are Sens. Heidi Heitkamp (D-N.D.), Mary Landrieu (D-La.), Mark Begich (D-Alaska), Mark Warner (D-Va.), Angus King (I-Maine), and Joe Manchin (D-W.V.).