The pledge by Republicans to repeal the Affordable Care Act(ACA) has reignited debate over needed reforms.

As CEO of Common Ground Healthcare Cooperative, one of only five Consumer Operated and Oriented Plans(CO-OPs) still standing nationwide since their formation under theACA, I have a unique perspective regarding potential solutions andimprovements to the ACA. Our CO-OP’s membership is primarilycomprised of individuals purchasing on the Exchange, and unlike aprivate insurance carrier, our non-profit health insurancecooperative focuses solely on member needs, without the influenceof external shareholders.

It is disheartening that the security of our members’ healthinsurance coverage is caught up in this political battle. Every decision we makeputs our members at the forefront and I implore Congress to applythat same philosophy to this debate – do what’s best for Americansrather than for your political party. If that was the case, ratherthan a repeal and replacement of the ACA, Congress would conduct acareful evaluation of what has worked and what has not and thenimplement effective reforms. This would provide ACA enrollees thesecurity of knowing their coverage will not be taken away and wouldalso assure the American people that our leaders are doing all thatthey can to address the costs of health care and healthinsurance.

Our members are very interested in lower health insurancepremiums and lower out-of-pocket costs, and we support an overhaulaimed at fixing problems with the ACA. But what’s missing from thepolitical debate is a real examination of why health insurancepremiums and consumer out-of-pocket costs are rising at a rate oureconomy can’t support.

There seems to be consensus on continuing to provide access tohealth insurance even with pre-existing conditions, yet there isalso interest in reviving high risk pools. How does one enroll in ahigh risk pool without a review of a consumer’s pre-existingconditions? This is but one example of how complicated this is andhighlights the need for a deep understanding of the healthinsurance and health care systems.

As Congress moves forward on ACA reform, I offer theseconsiderations:

• Individual mandate: There must be somemechanism in place so consumers don’t buy insurance only if theyneed it. I believe the penalty for not obtaining insurance shouldbe higher than the annual cost to purchase a health insurance plan– otherwise it’s an easy decision for consumers to not purchasehealth insurance. Without the ability to insure everyone, insurancecarriers can’t be expected to cover pre-existing conditions if theconsumer didn’t have continuous coverage. Without an immediate,effective replacement for the mandate, insurers will have no choicebut to exit the marketplace.

• Funding: Programs to stabilize premiums, oftencalled the 3 Rs for risk adjustment, reinsurance, and riskcorridors, were put in place for very good reason. These programswere designed to keep consumer premiums reasonable after high riskpools were eliminated and through the bumpy transition to theACA. I am offended by suggestions that the 3 Rs are an“insurance company bail-out” or “insurance company welfare.” Our CO-OP’s revenue consists mainly of premiums, ACA-relatedfinancial assistance for lower income members, and payments throughthese programs (far short of what was promised). Nearly all of ithas been passed along to providers and pharmaceutical companies.The high cost of health care must be addressed and consumers musttake responsibility for their health if we want to make healthinsurance affordable. Helping consumers afford their monthlyinsurance premiums is a critical and important aspect of reform,but premiums will continue to escalate if we don’t address theunderlying costs. In the interim, I recommend extending thetransitional reinsurance program, which makes payments to insurersfor their particularly costly members, because it is the only oneof the 3 Rs to actually work as intended.

• Close the loopholes: There are too many waysconsumers can take advantage of loopholes, leading to higheroverall costs for everyone. Special enrollment periods allowconsumers to obtain coverage only when they get sick, the 90-daygrace period on premiums enables consumers to get coverage withoutpaying for it and some providers encourage high-cost patients tokeep private insurance – allowing them to make more money – insteadof steering patients to government programs. These and otherloopholes all contribute to higher premiums for consumers who playby the rules.

Today, health care is nearly one-fifth of the US economy. Ourcountry deserves an honest, apolitical review of what has worked and what has not under the ACAand then a smart transition to improvements toward a healthiersystem. A repeal and delayed replacement is not in anyone’s bestinterest.

Contact info:

Cathy Mahaffey

Chief Executive Officer

CommonGround Healthcare Cooperative

120 Bishop's Way, #150

Brookfield, WI 53005

414-847-5469

[email protected]