After the latest Supreme Court ruling on Obamacare secured its survival, some of the law’s staunchest supporters have a clear message on what President Joe Biden should do next: Fix it.
The Affordable Care Act, after more than a decade of political turmoil, has never loomed larger. The law provided a new safety net during the coronavirus pandemic, mostly through its expansion of Medicaid. The Biden administration has boosted federal aid to purchase Obamacare coverage, which could help bring in millions of new customers. Insurers who fled the marketplaces in the law’s turbulent early years have returned, lured partly by the richer government aid.
But liberal health care policy experts are warning that the centerpiece of Obamacare, its heavily subsidized health insurance marketplaces where roughly 11 million people get coverage, has always lacked the kind of critical government oversight necessary to ensure the law lives up to its promises. In the absence of rigorous supervision, they say worrying trends like high levels of claim denials and narrow provider networks have already emerged in the marketplaces, which risk growing worse unless the Biden administration takes a tougher line with Obamacare health plans.
Although some Democrats over the years acknowledged problems with the health care law, they were reluctant to spotlight its flaws while it was under heavy GOP attack. But with last week’s Supreme Court decision likely signaling the end of the long-running war of Obamacare, advocates and experts are hoping the Biden administration will focus on shoring up its foundation — even as Democrats intensify their pursuit of other health reforms, like drug pricing and expanding Medicare.
“The ACA has been transformational for the people we represent, but if we allow the decay to happen behind the scenes, these stories are the ones that are going to steal the narrative,” said Katie Berge, a former Obama administration health official who’s now the director of federal relations for the Leukemia & Lymphoma Society.
Biden campaigned on building up Obamacare rather than pursuing an expensive “Medicare for All” model favored by his party’s progressive wing. He’s pushing Congress to make permanent a temporary expansion of the law’s health insurance subsidies that was included in this year’s Covid relief package, but he’s remained tight-lipped about much of his broader health care agenda beyond rolling back Trump administration policies opposed by Democrats.
The Department of Health and Human Services is “always looking for ways to improve oversight and efficiently allocate resources to monitor the compliance of regulated entities,” a spokesperson said in an emailed statement. “We do not take this responsibility lightly and have instituted high standards and regulations that ensure that the millions of people who have health coverage through a marketplace plan are getting the highest possible quality at lowest possible cost.”
Yet experts and advocates say Biden officials must ramp up scrutiny of issues that have lingered since the law’s inception or worsened under the Trump administration’s apathy toward the law.
“We’re at a moment when insurers are no longer running away from the exchanges and there’s relative stability in the individual market — and this is a moment that insurance regulators and policymakers should be asking how do your marketplace plans work better for consumers?” said Kevin Lucia, a former Obama administration health official who worked on the law’s implementation.
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