2015 promises a lot of political activity in health care. Recent wins in Congress, along with increased power at the state level mean that Republicans can influence our health care system in ways they could not before. This could have a huge impact on health care consumers nationwide, and Democrats need to be ready. Following are three New Year's Resolutions that Democrats would do well to heed.
1. Prepare for an adverse King v. Burwell ruling.
This is mostly for state-level Democrats. The Supreme Court is set to hear this case in March and a ruling could come down as early as June. If the plaintiffs win, millions of Americans who purchased their health insurance on a federal health insurance exchange would lose the subsidies that helped them pay for it. Because those subsidies trigger the employer penalty, it would also mean that employers could avoid the penalties associated with not offering coverage.
Generally, Democrats would view this as a negative development. Why? If the subsidies go away for policies purchased on a federal exchange, it is likely that millions of Americans would drop their coverage and become uninsured again. This would make the insurance pools smaller and most likely sicker, threatening the solvency of a program closely associated with their party.
To avoid this, state-level Democrats in the 27 states that refused to set up a state exchange should push hard to get one set up. They should argue that relying on the federal government's exchange is costing the state's citizens billions in federal subsidies. Republicans will argue that it is saving the state's employers in penalties. Democrats need to be ready for that, and to have a concrete plan for getting a state exchange set up in time for 2016's open enrollment.
2. Position the lack of Medicaid expansion as hurting the state's economy.
Both federal and state-level Democrats can have an impact here. Many Republican-led states did not expand Medicaid when first given the opportunity under health care reform. This was partly due to an expectation that states would have more negotiating power with the federal government in future years to design their expansion the way the state wanted, rather than the way the federal government wanted.
Recent announcements in Tennessee indicate that the federal government is indeed getting more flexible. As such, Democrats should step up their messaging that it is long past time for all states to expand Medicaid.
In doing so, Democrats should shift the focus of their messaging from the plight of the uninsured to the harm that Republican leaders are doing to their state's economies by not expanding Medicaid.
Why is that? Well, citizens of every state pay federal tax dollars for Medicaid. If one's state doesn't expand Medicaid, that state doesn't get the federal money. Other states that do expand Medicaid, though, do get the federal money. As a result, when Texas refuses to expand Medicaid, it is sending its citizens' federal tax dollars to Massachusetts and California. Expanding Medicaid, on the other hand, would mean billions of federal dollars coming back into Texas.
State-level Democrats should elevate this angle of the argument when pushing for their states to expand Medicaid. Let state-level Republicans explain why they are okay with their citizens' federal tax dollars flowing to the blue states.
3. Have a plan for the renewal of CHIP funding.
This is for federal-level Democrats. "CHIP" stands for the "Children's Health Insurance Program." This is a federal "block grant" program that provides coverage for children. It is due for congressional renewal this summer. Republicans often argue that it provides a better model than Medicaid, in that it is funded with "block grants" to the states rather than being "open-ended" in nature. Because federal funding for CHIP is not "open-ended," states are allowed to freeze enrollment in it when costs get out of line or an economic downturn hurts a state's ability to pay for the program. While this is used as an argument against "block grants," it also means that the program is more sustainable financially.
The bottom line here is that the vote to renew CHIP funding is another opportunity for Republicans to influence the U.S. health care system in 2015. Democrats need to have a plan to secure a renewal of the CHIP program "as is" without sacrificing priorities in other areas.
The degree to which Democrats are prepared and proactive in these areas will have a big impact on what the options are for health care consumers nationwide.