By Robert Donachie
Republican and Democratic senators are working on a solution to fix the problems with Obamacare, seemingly dropping all discussions of repealing and replacing the current system that dominated political discourse for the majority of President Donald Trump’s first year in office.
Senate Health Committee Chairman Lamar Alexander kicked off a series of hearings Wednesday that are focused on finding a way to both stabilize the Affordable Care Act and individual health insurance marketplaces and prevent premiums from soaring in 2018. Soaring premiums have been a persistent problem for individuals enrolled on the Obamacare state exchanges. Alexander hopes to have a piece of legislation crafted by Sept. 15.
“I propose that we come to a consensus by the end of next week when our hearings are complete so that Congress can act on it before the end of September,” Alexander said Wednesday. “Otherwise we will not be able to affect insurance rates, and the availability of insurance, for next year.”
Republicans seven month long effort to upend the American health care system failed in late July, after three Republican senators – John McCain of Arizona, Lisa Murkowski of Alaska and Susan Collins of Maine – voted down the party’s last-ditch proposal to repeal Obamacare.
Alexander started Wednesday’s hearing with a potential compromise for his colleagues across the aisle: Republicans will put forth a bill to continue paying insurance companies Obamacare subsidy payments –cost-sharing reductions (CSRs) — that help cover the cost of deductibles for low-income consumers on the exchanges. In return, he asked that Democrats allow for the expansion of state waivers — commonly known as 1332 waivers — that allow states to innovate their implementation of Obamacare as long as they meet the basic ACA protections.
The ranking Democrat on the committee, Sen. Patty Murray of Washington, said that while coming to a compromise would likely be anything but simple, it is certainly within the realm of possibility.
The Senate health committee invited state insurance commissioners from Alaska, Oklahoma, Tennessee and Washington, along with the former insurance commissioner of Pennsylvania to testify. While they all had different proposals for fixing the health insurance marketplaces, they agreed on one thing: Congress must act with haste to ensure CSRs are paid out through 2018, if not further.
The president has considered ending CSRs on numerous occasions, but it has been making payments on a month-to-month basis in the face of an impending lawsuit filed in 2014.
The other two solutions floated Wednesday from insurance commissioners were a federal reinsurance program and continuing federal funding for insurance counselors, also known as navigators, who help people navigate the insurance marketplace.
A reinsurance program has the potential, as it has in Minnesota, to provide insurance companies with enough confidence to participate in the exchanges. In the simplest of explanations, reinsurance is meant to reduce the incentive for insurance companies to raise premiums because of higher-risk enrollees. Insurance counselors, or navigators, can be particularly important in highly-rural areas, where it can be difficult to find insurance providers and maneuver through marketplaces with very little information.
The health committee held another hearing Thursday, where sitting members invited Republican Govs. Gary Herbert of Utah, Charlie Baker of Massachusetts and Bill Haslam of Tennessee and Democratic Govs. John W. Hickenlooper of Colorado, and Steve Bullock of Montana to discuss the problems they face with enrollment and premium increases in their state’s Obamacare marketplaces.
Like the state health commissioners, all five governors urged Congress to continue paying out Obamacare subsidies, with Bullock calling on lawmakers to consider funding them through 2020 to ensure marketplace stability. The governors also want Congress to look at reinsurance programs and broader state waiver options to allow states to tailor Obamacare to their unique populations.
Along with these requests, Haslam and Baker called for Congress to address the rising costs of health care.
“It is my strong hope that this committee will then turn its sights to the cost of health care, which is crippling businesses and families and overwhelming all of the other needs that should be addressed in state and federal budgets,” Haslam said Thursday.
“Surely all lawmakers can agree this country has a fundamental problem as long as medical inflation is increasing at almost twice the rate of inflation of everything else. If not, as someone once quipped, ‘the United States government is about to become a large health insurance company with a small army attached to it,’” he said.
Health insurers have till Sept. 27 to finalize their insurance plan offerings for the 2018 Obamacare state exchanges. Alexander reiterated Thursday that the committee’s “goal is to get a result in a very short period of time on a 2018 stabilization package,” Alexander said. The package could include some concessions to Democrats, like a form of reinsurance, although that has less potential to pass on such a short timeframe.
The one key take-away from the week’s hearings is that Republicans, at least for now, are looking for ways to fix Obamacare.
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