Dr David Cutler Discusses Opportunities for Bipartisan ACA Reform

There are some areas in health policy where Democrats and Republicans can find common ground, like incentivizing greater value, but bipartisan talks won’t happen while there are still active efforts to repeal the Affordable Care Act (ACA), said David M. Cutler, PhD, of Harvard University.

Transcript (slightly modified)

What areas of the Affordable Care Act do you think can be reformed and improved if Republicans reach across the aisle and work with Democrats?

There’s a lot in the ACA that needs to be addressed and that could be addressed with bipartisan support. The issue about many places in the country where insurers are not entering or leaving is a really big deal that should be addressed. Issues about, are the subsidies adequate for certain types of people or the nature of the policies that people are subsidized for are, again, something where if we had bipartisan support it would be good.

Some of the back-office things, like reinsurance programs and risk adjustment programs for insurers so that they’re not panicked about getting a couple of very unhealthy people are all things that ought to be addressed. And then, things about the organization of the Medicare program, how it goes about paying for things, how it incentivizes greater value in healthcare. All of those are things that, if there were interest, could be done on a very bipartisan basis.

What is the likelihood of bipartisan work being done on reforming the ACA?

Bipartisanship is such a dirty word these days. It won’t happen while there’s ongoing talk of repeal of the ACA, because the Republicans can’t be seen as having a separate set of discussions and Democrats don’t want to feed into discussions that will be used to argue for repeal. I think if repeal looks like it’s going to fail, you may then see some discussions that look like, okay, can we find some things to do that make things work better? There is a lot that could be done there. I think we probably have a little bit more to go before that becomes more of a front-stage issue.