Now that the latest GOP health care proposal is being left for dead, you might think that health care reform efforts are over for the near future. But don't dismiss bipartisan efforts already underway that aim to stabilize the insurance market and potentially give states more flexibility in meeting federal standards.
That's the sentiment of Bernard Tyson, chairman and CEO of Kaiser Permanente, which provides health care to 11.8 million members in eight states and the District of Columbia. Tyson talked with Morning Edition host David Greene this week about what a health care compromise could look like, and how to get there.
Tyson dismisses the idea that the insurance exchanges created under the Affordable Care Act, also known as Obamacare, are collapsing. While he acknowledges that there have been challenges because of the uncertainties of what requirements will be included in the program next year, and sees the system as vulnerable, "as of right now, no, it's not close to collapsing," he says.
"I believe strongly that if the government solves a few vital areas, insurers who got out of the market will get back into the market," he says, referring to insurers that have pulled out of the exchanges, or threatened to for 2018.
One way to get better decisions about health insurance is to put it in the hands of state governments, Tyson says — which is what Republicans have been focused on.
"That said," he adds, "there should be some rules of the road, which are the guardrails — as in the Affordable Care Act."
The "guardrails" could be federal standards for things like preventive care, maternity care and hospitalization, he says.
"There have got to be, in my view, some guidelines so everyone is clear about the threshold requirements across the country," Tyson says, "given that we're trying to solve a societal issue, which is [that] millions of Americans are still locked out of the front door of the American health care system."
He sees room for compromise — agreeing to some federal standards, but also offering states a degree of flexibility in how to best allocate some health dollars to certain health issues. For example, states might know best about how to direct money to fight the opioid epidemic, he says; that could vary by region.
Tyson says a compromise on the health law can happen "as long as Republicans can agree that what we don't want to do is end up with modifying the law [in a way that] people will lose access."
He cautions that partisanship will only lead to more insurance instability.
"I think the reality is that the Affordable Care Act was enacted based solely on the Democratic side of the house," Tyson says. Now, "to those who believe the ACA is a 'disaster' that we will solve by coming up with another partisan solution — that's not good for this country."
Morning Edition's Tony Liu, Jessica Smith and David Greene edited and produced the audio version of this interview.
DAVID GREENE, HOST:
Republicans have now officially abandoned the Graham-Cassidy bill. That was their latest effort to repeal the Affordable Care Act. Yesterday Tennessee Republican Lamar Alexander said he wants to return now to a bipartisan plan he's been working on that would stabilize the insurance exchanges, and that was music to the ears of a health care CEO I was talking to.
So do you see a bipartisan way forward here?
BERNARD J. TYSON: Absolutely. And I hope that we can now get that back on track.
GREENE: That is Bernard J. Tyson. He is CEO and chairman of Kaiser Permanente, the nonprofit medical insurer and provider that serves about 12 million Americans. Kaiser is still on many of the insurance exchanges even as political uncertainty has driven others away. Tyson testified about a possible bipartisan way forward this month on Capitol Hill.
TYSON: I left that discussion optimistic that both the senators on the Republican side and the Democratic side were truly trying to figure out how to reach a consensus on making some changes that would stabilize this marketplace.
GREENE: How close are the exchanges to collapsing, as Republicans have been talking about?
TYSON: I believe strongly that if the government solves a few vital areas, insurers who got out of the market will get back into the market. So yes, we can prevent the inevitable if we do nothing, which is, eventually it might collapse. But as of right now, no, it's not close to collapsing.
GREENE: You have seemed to agree with Republicans in principle. I mean, with Graham-Cassidy, we heard Republicans talking about more state flexibility and dealing with health insurance. What part of that do you like?
TYSON: If you look at what's behind that, it gets to where can you make the best decisions about how to tailor the law for the people in your direct line of sight? The question is should that be handled at the federal level or the state level? And I would argue that it is best handled at the state level. That said, there should be some rules of the road, which are the guardrails, as in the Affordable Care Act, which is really in the interest of making sure that the consumer is protected.
GREENE: What is an example of an idea that would move toward state flexibility that might be hard for some Democrats to swallow but would be necessary to bring Republicans onboard?
TYSON: I think that as long as the Republicans can agree that what we don't want to do is end up with modifying the law where people will lose access to the front door of American health care system, meaning we stop covering certain things, that is a central to my belief of what a person would need to have for coverage - what kind of preventive care, how hospitalization would be covered, making sure maternity benefits are covered in the right way. So to figure out, you know, what's going to be required, but then to give the state flexibility to emphasize those areas in some cases that might be appropriate for what's going on in those particular states. And so...
GREENE: So you mean, like, something like opioids for example? If one state is dealing with that problem much more, there could be some broad requirements but a state could say I want more money, more emphasis on that problem because my state's suffering?
TYSON: That's exactly right.
GREENE: You think Obamacare was too partisan?
TYSON: I think the reality is that the Affordable Care Act was enacted based solely on the Democratic side of the House. And, I think going forward, to those who believe that the Affordable Care Act is a disaster that we will solve by coming up with another partisan solution is not good for this country.
GREENE: Can I just finish by asking if you worry, in the political climate of recent years, that your optimism is unrealistic?
TYSON: No, I don't worry about that. I seen too many examples where we've had massive disagreements but we have figured out as a great country how to come to a solution. One of the beauties of our country is the freedom to disagree, the freedom to speak about those disagreements. And I believe that we will continue to evolve to solve these problems.
GREENE: Bernard J. Tyson is the CEO of Kaiser Permanente, and he was talking to us from our bureau in New York City. Thanks so much.
TYSON: Thank you. Transcript provided by NPR, Copyright NPR.