By Dianne Feinstein

Originially published in Medium

Despite the Trump administration’s year-long effort to sabotage the Affordable Care Act’s individual insurance markets, those markets proved resilient, particularly in states like California that worked hard to implement the law effectively.

However, the coming months are critical as health plans insurers are preparing to submit their 2019 rates based on expectations for next year’s market and level of stability.

While Republicans have worked to take away health care from Americans through their years-long effort to repeal and undermine the Affordable Care Act, poll after poll shows that the public believes responsibility for negative outcomes belong to the Republican party.

This and the fact that their four repeal bills failed should motivate Republicans to finally abandon these efforts and work with Democrats in a bipartisan way to address affordability problems in the individual market and ensure stability for the upcoming enrollment period.

A simple solution that would vastly improve affordability for middle-class families and stabilize the individual market in the short-term is to eliminate the sharp cut-off for tax-credit subsidies that blocks middle-class families from receiving affordable premiums.

In California 378,000 people are projected to drop out of the market if we don’t act to make insurance more affordable for all middle-class families.

Under current law, individuals and families making between 300 and 400 percent of the federal poverty level receive tax-credit subsidies to ensure they pay no more than 9.69 percent of their monthly income on health insurance premiums.

However, individuals and families making just one dollar more than 400 percent of the poverty level?—?$47,520 for an individual and $80,640 for a family of three?—?receive no financial help at all.

A 60-year-old making $47,521 per year?—?one dollar more than the limit?—?has to pay more than $1100 per month in premium costs for a standard plan in the Bay Area, for example.

At over 25 percent of gross take-home pay, that’s clearly unaffordable.

Under our bill, the Affordable Health Insurance for the Middle Class Act, the 400 percent of poverty cap would be eliminated so tax-credit subsidies would be universal and gradually phase out. No individual or family would pay more than 9.69 percent of their monthly income toward health insurance premiums. Once premiums are less than this percent of income, no tax-credit would be received. It’s a fair way to ensure access to affordable coverage.

This change would significantly benefit communities?—?both rural and urban?—?where the cost of providing health care is particularly high.

For example, a Bay Area resident making $50,000 would pay no more than $404 per month, saving around $700 per month compared to current law.

Those individuals eligible for subsidies who have chosen to go without coverage are likely to be much healthier than the market overall. Incentivizing them to get covered is key to maintaining the right balance between healthy and sick enrollees and keeping costs under control?—?which lowers premiums for everyone.

Older Americans between ages 50–64 would see the greatest benefit because they pay up to three times more for insurance. It’s estimated that 96 percent of the newly insured would be in this age group.

Expanding eligibility for tax-credit subsidies would partially pay for itself. By attracting healthier people to the market and lowering premiums, the federal government would spend less on tax-credit subsidies for those who already receive them.

The American people want us to solve problems. They want us to work together to improve?—?not repeal?—?the Affordable Care Act. The sooner Republicans come to the table to work on real solutions, the sooner middle-class families will benefit.

The American people want us to solve problems. They want us to work together to improve?—?not repeal?—?the Affordable Care Act. The sooner Republicans come to the table to work on real solutions, the sooner middle-class families will benefit.