Govs. John Hickenlooper (D-CO) and John Kasich (R-OH) released what they are calling a “bipartisan blueprint” for stabilizing the Affordable Care Act Thursday, but many of their “fixes” detailed in a letter to congressional leadership are simply pleas that the law be enforced as written.

“We’re not trying to start a revolution here,” Hickenlooper said at a press conference in Denver Thursday. “These are very cautious, pragmatic efforts.”

Six other governors from across the country, Govs. Brian Sandoval (R-NV), Tom Wolf (D-PA), Bill Walker (I-AK), Terence R. McAuliffe (D-LA), John Bel Edwards (D-LA), and Steve Bullock (D-MT), signed onto Hickenlooper and Kasich’s blueprint. Hickenlooper told reporters Thursday he wanted 15 governors from each party to get on board, but that that was an “unreasonable goal.”

… w/ federal Govt. Lasting solutions will need support from all sides and we look forward to working together https://t.co/0VRLfbnG1A 3/3 — John W. Hickenlooper (@GovofCO) August 31, 2017

Although changes to the law are ultimately in the hands of Congress, Hickenlooper said he hoped the governors could offer some insight into potential fixes, as each of them is implementing the law on the state level.

“Continuing uncertainty about the direction of federal policy is driving up premiums, eliminating competition, and leaving consumers with fewer choices,” the letter said. “Proposed premiums for the most popular exchange plans are expected to increase 18 percent in 2018 and 2.5 million residents in 1,400 counties will have only one carrier available to them on the exchange.”


The increase in premiums and dwindling number of options on the exchange can, in many cases, be traced back to uncertainty stoked by President Trump, as insurers must explain their rationale for requesting rate increases, and many have pointed to uncertainty about whether the president will uphold the law in their explanations. A number of insurers who have pulled out of the market have also cited a lack of clarity about the future of the law as reason for leaving.

Republicans in Congress (and now in the White House) have worked for many years to undermine the Affordable Care Act. Their efforts have ultimately been successful (despite three failed attempts to repeal and potentially replace Obamacare) as is evidenced by the fact that the blueprint released by the governors Thursday is not revelatory. It does not contain creative fixes to the law that have not been proposed by think tanks or other politicians.

The proposal is further evidence that the health care debate has become so toxic in recent years that the “bipartisan blueprint” for moving forward and stabilizing the markets is, on many levels, just a request for proper enforcement of the law.

The first of several recommendations they make that the Trump administration commit to paying the cost-sharing reduction payments, which are payments the executive branch makes to insurers to offset the costs of covering lower-income people.


The payments are the subject of a lawsuit filed by House Republicans during the Obama administration, which the House Republicans won. The Obama administration appealed the decision and continued to make the payments, but the Trump administration could drop the appeal and stop making the payments at any time.

The uncertainty around the future of CSR payments has been a major concern since Trump took office, because, as Hickenlooper and Kasich’s letter notes, if the executive branch stops making CSR payments, the Congressional Budget Office estimates premiums will rise 20 to 25 percent and increase the federal deficit $194 billion over the next decade.

Additionally, the governors call for Congress to explicitly appropriate funds for the CSR payments at least through 2019.

“This guarantee would protect the assistance working Americans need to afford their insurance, give carriers the confidence they need to stay in the market, increase competition, and create more options for consumers,” the letter says. “Because the cost of this initiative is already included in the budget baseline, the appropriation would not have budget consequences.”

Hickenlooper and Kasich also call for the individual mandate, which is central to the law, to be kept “for now.” The individual mandate requires that everyone purchase health insurance in an effort to bring younger, healthier people into the insurance pools, which offsets the costs of insuring older and sicker people.


“To prevent a rapid exit of additional carriers from the marketplace, Congress should leave the individual mandate in place until it can devise a credible replacement,” Thursday’s letter says.

“The current mandate is unpopular, but for the time being it is perhaps the most important incentive for healthy people to enroll in coverage. Until Congress comes up with a better solution – or states request waivers to implement a workable alternative – the individual mandate is necessary to keep markets stable in the short term.”

The governors make several other recommendations in their blueprint, including “maximizing market participation,” in order to improve the risk pool by having younger, healthier people in the market, and that the federal government streamline the process for state innovation waivers.

The waivers allow states to request permission to waive certain aspects of the ACA in an effort to strengthen the health insurance markets as long as they can prove doing so would not make coverage less affordable, increase the federal deficit, or reduce the number of insured people in the state.

This blueprint is the result of true and real compromise in practice. Republicans and Democrats CAN work together for the common good. 5/ — John Kasich (@JohnKasich) August 31, 2017

They also ask that, in an attempt to stabilize Obamacare, Congress not shift costs onto the states.

“Reforms should not shift costs to states or fail to provide the necessary resources to ensure that the working poor or those suffering from mental illness, chronic illness or addiction can get the care they need,” they write.

Notably, one plan that has gained some traction in recent weeks is a plan to do just that. The proposal, led by by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), would essentially block grant health care to the states in an effort to shift costs off the federal government and give states more flexibility. The proposal also comes as support for single-payer is picking up steam in the Senate among high-profile Democrats.

Asked Thursday which governor had developed which part of the blueprint, Hickenlooper declined to specify, saying, “That’s exactly what got the Beatles in trouble.”