A Quick Look at Congress’s Ideas to Improve Private Health Insurance

Politicians have debated bold proposals to reform the health system in the wake of last year’s failed effort to repeal and replace the Affordable Care Act (ACA). Conservatives have closed in on the idea of a massive state block grant as a substitute for the ACA’s Medicaid expansion and Health Insurance Marketplace subsidies. Progressives have introduced versions of expanded public health insurance plans such as Medicare for More or Medicare for All. Candidates will likely debate these types of proposals in the 2020 run for the White House.

Yet the benefits of any future health reforms signed into law by a new president would be, even optimistically, still half a decade from realization. This helps explain why lawmakers have introduced numerous less radical, but more actionable, proposals to improve current insurance’s quality, affordability, and enrollment. Some of these bills would restore funding or consumer protections that were rolled back by the Trump administration (for example, reimposing ACA protections for people with pre-existing conditions on short-term health plans). Others seek to inject public policies into the private markets to improve their performance (for example, “reinsurance” or federal payments to insurers for their most expensive enrollees’ costs). A subset has gained bipartisan support. Beneath the cloud of partisanship over health policy, it is still possible that Congress will pass policies that help Americans afford quality coverage.

This table summarizes legislative proposals introduced in the 115th and 116th Congresses that exclusively aim to lower costs and increase enrollment in individual and small group health insurance. The table includes columns for policies that experts largely agree would make health coverage more affordable and accessible; it excludes policies that may not achieve these outcomes, such as expanding health savings accounts. For purposes of brevity, it also excludes the wide range of proposals focused on reducing the price of prescription drugs in Medicare and in the private market, which could reduce the cost of individual and small group insurance. If a bill was reintroduced in largely the same form in the 116th Congress, the chart only includes the most recent bill.

As the table shows, recent bills tend to focus on restoring rather than expanding the ACA’s health insurance regulations. Expansions tends to focus on holding insurers accountable for high rate increases, high overhead and profits, and “surprise” medical bills (typically, an unexpected bill from an out-of-network provider at an in-network hospital). Reinsurance is common, with lawmakers proposing different roles for states in administering it. Similarly, several bills would restore the payments to health plans for cost sharing subsidies halted by President Trump, although recent evidence suggests that this attempt to undermine the ACA backfired—instead, lowing costs for enrollees with income from 200 to 400 percent of poverty. A number of Democrats’ bills would increase premium tax credits: across the board, for middle-income enrollees, or for young adults. Doing so would likely increase enrollment as well as help current enrollees afford coverage. Legislation also would increase funding for education and enrollment activities—which will increase in importance this year, with a tax penalty no longer associated with being uninsured when coverage is affordable.

Editor’s note: from June 26, 2019 onwards, the information in this table has been managed and updated by TCF senior fellow Jen Mishory.

Table 1

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