Momentum builds for bipartisan compromise on ACA/Obamacare fixes

20768265_1276397345823255_1692197878651813289_nMara Lee wrote that a group of Republican and Democratic governors last Thursday implored senators to continue paying insurers for cost-sharing reductions (CSR) to shore up the unstable exchange markets.

Three Republican and two Democratic governors told members of the Senate’s Health, Education, Labor, and Pensions Committee that paying cost-sharing reductions is the most important thing they can do to prevent premium spikes and insurer exits. The recommendation came just one day after several state insurance commissioners called for at least two years of guaranteed cost-sharing payments.

Utah Gov. Gary Herbert, a Republican, recommended Congress approve the CSRs through 2019 even though he feels they aren’t the most effective way to help low-income individuals.  The proposal is gaining momentum with lawmakers. Sen. Lisa Murkowski (R-Alaska), a swing vote who helped kill a partial repeal of the ACA, said what matters on appropriating money for CSRs is that both parties agree it should be done.
“Whether it’s one year, two years or perhaps longer, we can figure that out,” she said.

The committee is trying to pass a narrow bipartisan bill by Sept. 15, so a law can be signed before insurers have to commit on Sept. 27 on where they’ll sell policies and how those policies will be priced. I think these timelines are dreams again and wish Congress would start to stop believing in the fairy tales and magic and get down to reality. The bipartisan part of the solution is a great start.

“It sends a signal to the country (that) we’ve broken the seven-year stalemate” since the Affordable Care Act, committee Chairman Lamar Alexander (D-Tenn.) told reporters at the end of the second of four hearings for the bill. The Affordable Care Act passed seven years ago with no Republican votes, and members of the party—including Alexander—repeatedly vowed to repeal the law.

CSRs have had a substantial impact on proposed 2018 rates, with some insurers requesting double-digit increases due to the unknown fate of CSRs. The Congressional Budget Office has projected that premiums will increase by 20% next year without guaranteed CSRs.

The Republicans in the House of Representatives sued over the CSR payments, saying the executive branch violated the separation of powers by funding them. A federal court sided with the House and the case is now on appeal. Until the appellate decision is made, the Trump administration has continued to pay the CSRs, while repeatedly threatening to stop.

If Congress appropriates the money now, the lawsuit—and Trump’s threats—will become moot.
The governors’ requests for renewed federal reinsurance funding drew less support. Although the governors said their states cannot raise money quickly enough to provide reinsurance to offset high-cost patients’ care, Alexander said that would have to wait for a longer-term solution.

“Creating a brand new reinsurance pool in the next 10 days is just not going to happen,” he said. “There isn’t any way to do that.” The CMS said in June that issuers requested $7.5 billion in federal reinsurance payments for the 2016 benefit year, the last year transitional reinsurance was funded in the law. The federal program covered about half of the cost of claims between $90,000 and $250,000 a year for any individual who had more than $90,000 claims that year.

Alexander noted that both Republicans and Democrats on the committee have asked whether opening up catastrophic plans—also called copper level—to all customers might convince more people to get covered, and thereby help the risk pool. Giving customers more choice appeals to Republicans and may be part of a compromise bill.

Also, now after Republicans in the Senate spectacularly failed to deliver on their promise to repeal and replace the Affordable Care Act, also known as Obamacare, a smaller group of lawmakers is trying a new approach: Bring in the Democrats and aim low.                                                                                                                                                It starts next week when the Senate Health, Education, Labor, and Pensions Committee holds the first of four hearings over two weeks with the goal of passing a modest bill to help stabilize the Obamacare health insurance markets for 2018. Committee Chairman Lamar Alexander, R-Tenn., says he’s looking to do something “small, bipartisan and balanced.” What’s remarkable is that he made that statement in a joint press release last month with the committee’s ranking Democrat, Sen. Patty Murray, D-Wash.

Up until recently, all major Republican efforts to alter Obamacare were launched with no Democratic support, and no attempts to get any.

Alexander and Murray say they want to work first to stabilize the markets for next year and then perhaps move on to broad reforms that will attract more insurance companies to compete in the individual markets, potentially making prices lower for consumers.

They’ve got a short window. Insurance companies have until Sept. 27 to sign contracts committing them to offering health plans on the Affordable Care Act exchanges next year, and setting their prices.

Alexander says his priorities include getting Congress to commit to funding so-called cost-sharing subsidies — payments that reimburse insurance companies for giving their lowest-income customers discounts on deductibles and co-payments.

President Trump has threatened to end the payments and has refused to even say whether the government will make them for the final four months of this year.         “State insurance commissioners have warned that abrupt cancellation of cost-sharing subsidies would cause premiums, co-pays and deductibles to increase and more insurance companies to leave the markets in 2018,” Alexander said in a statement last month. “Congress now should pass balanced, bipartisan, limited legislation in September that will fund cost-sharing payments for 2018.”

Alison Kodjak reported that Sen. Lamar Alexander, R-Tenn., and Sen. Patty Murray, D-Wash., announced today that the Senate Health, Education, Labor, and Pensions committee would hold bipartisan hearings on ways to stabilize the Affordable Care Act marketplaces for 2018.

The hearings will start the week of Sept. 4. Their aim is to act by Sept. 27, when insurers must sign contracts to sell individual insurance plans on for 2018.

Alexander says the committee will hear from insurance commissioners, consumers, governors, insurance companies and health care experts. If Congress doesn’t act, he says, some people could find that they have no exchange options, and millions of people would find insurance unaffordable.

Alexander also urged President Trump to continue what insurance companies through September know as “cost-sharing reduction”(CSR) payments. These payments help to lower co-pays and deductibles for low-income Americans who earn 100 to 250 percent of the federal poverty level. The Trump administration has been dolling out the payments on a month-to-month basis and threatening to end them altogether, which is spooking insurers into raising rates.

Alexander stressed that stabilizing the marketplace for 2018 is only step one and that after that, lawmakers will continue to work towards a more robust individual insurance market for the long term.

The announcement came after President Trump took to Twitter to threaten insurance companies that he may withhold payments to insurers in an effort to undermine the Affordable Care Act.

If ObamaCare is hurting people, & it is, why shouldn’t it hurt the insurance companies & why should Congress not be paying what public pays?

It’s not the first time the president has threatened to cut off these payments, which he refers to as “BAILOUTS.”

If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!

But these payments aren’t designed to compensate insurers for business failures. Rather, they reimburse insurance companies for discounts the law requires them to give to low-income people who buy insurance through the Affordable Care Act exchanges. The federal money offsets the money insurers lose by lowering the deductibles and co-payments they require of these policyholders.

Trump, who is angry that the Congress failed to pass a law to repeal and replace the Affordable Care Act, or Obamacare, has been wielding his threat to withhold these CSRs — which could cause chaos in the insurance markets – in hopes of forcing lawmakers back to the table to try again to get rid of the health care law.

The next cost-sharing payments are due to be paid in a few weeks and the president has said he’ll announce this week whether he’ll pay the money or keep it in the Treasury.

“In the absence of the CSR, the rate increases could be astonishing,” says Dr. Marc Harrison, CEO of Intermountain Healthcare, which operates nonprofit hospitals and clinics and insures more than 800,000 people across Utah.

“We’ll see [the number of] people who are uninsured, or functionally uninsured, go way, way up,” he adds.

Harrison says he and his company filed two sets of proposed rates for policies sold on the insurance exchange next year. If the president cuts off the cost-sharing payments, he says, the rates will be much higher.

The Congressional Budget Office estimates the payments, if they’re all made, will total $7 billion this year. Margaret Murray is CEO of the Association for Community Affiliated Plans, which represents these “safety net health plans” aimed at people with lower incomes. She says she has been in touch with the Department of Health and Human Services to urge them to fund the payments.

“Should the payments cease, insurers will be required to fund cost-sharing reductions on their own,” Murray says. If that happens, “they will either raise their rates – our plans indicate that it could be by up to 23 percent – to compensate for these losses, or they will withdraw from the markets altogether.”

If Trump does decide to stop making the payments, it may end up costing the U.S. Treasury more, while insurance companies who remain in the markets could do just fine.

That’s because insurance companies will charge more in premiums to make up for the lost payments. And that will lead the Treasury to spend more on subsidies to policyholders who qualify, according to an analysis by the consulting firm Oliver Wyman. If those subsidies go up enough, more people could be lured into the exchange markets.

Here’s the wonky reason why: The Obamacare exchanges require insurance policies to conform to one of four “metal” levels — bronze, silver, gold or platinum — which coincide with how much an individual is expected to pay in premiums, deductibles, and other out-of-pocket expenses. A bronze plan covers about 60 percent of a customer’s health care costs, with relatively low monthly premiums, while a platinum plan will cost more each month but pay 90 percent of total health costs.

Of course, ending CSR payments, especially if it’s done with little warning, would produce a certain amount of chaos and uncertainty.

Congress could remove all the uncertainty surrounding CSR payments by appropriating the money. And, CBO is already assuming it gets spent.

The law provides income-based tax credits to people to buy insurance, and those credits are calculated based on the price of silver plans. Last year about 85 percent of people who bought Obamacare insurance got a credit, according to the Center for Medicare and Medicaid Services.

People with the lowest incomes also get those discounted deductibles and co-payments if they buy a silver plan, and then the government reimburses insurers through CSR payments.

If Trump decides not to make those payments, insurance companies are likely to raise rates about 19 percent, according to an analysis by the Kaiser Family Foundation.

That means subsidies will have to rise for many people to meet those higher premiums. Some people may take that bigger subsidy to buy a cheaper policy — and many could even get insurance for free, according to Oliver Wyman, because premiums on bronze plans probably would not rise as much as those on silver plans.

The higher subsidies could cost the government as much as $2.3 billion in 2018, according to the Kaiser Family Foundation’s Larry Levitt. Levitt notes that Congress could end the ambiguity over the payments by appropriating the money for them.

Sen. Orrin Hatch, R-Utah, said in an interview with Reuters that he thinks Congress will do just that.

“I’m for helping the poor; always have been,” Hatch said. “And I don’t think they should be bereft of health care.”

The reason CSRs are in limbo at all is that House Republican who did not want Obamacare to succeed sued the administration, claiming the payments to insurers were illegal because they had not appropriated money for them.

A federal judge agreed, but the Obama administration appealed. When Trump took the White House he continued the appeal, to allow lawmakers time to pass a bill to repeal Obamacare and make the payments disappear altogether.

Now that that effort has failed, the lawsuit and the cost-sharing money are once again in play.                                                                                                                                    He also wants the federal government to make it easier for states to get waivers so they can implement health policies that differ from Obamacare.

Wednesday’s hearing will feature insurance commissioners from four states, including Julie Mix McPeak from Alexander’s home state of Tennessee. She’s called for assurances that the payments will continue.

“When there’s any uncertainty surrounding the continuation of those payments, the insurers are doing two things. They are raising premium rates for 2018 and they’re making decisions about whether or not to participate in the individual exchange markets across the nation,” McPeak told NPR’s Ari Shapiro in August.

On Thursday, governors from four states will testify. They include John Hickenlooper of Colorado, who together with Gov. John Kasich of Ohio recently proposed their own bipartisan plan to overhaul the insurance markets.

Their plan includes creating a two-year reinsurance fund to protect insurers from people who have severe illnesses and make big claims. It would also exempt insurance companies from certain taxes if they enter a market in which there’s little to no competition.

The governors’ plan also advocates maintaining the so-called individual mandate, which requires everyone to own health coverage or pay a fine. That mandate is one of the most hated elements of Obamacare among Republicans and President Trump has suggested that his administration will make little effort to enforce it.

Hickenlooper and Kasich laid out their plan last week in a letter to congressional leaders that was signed by the Republican and Democratic governors of eight states, including Gov. Brian Sandoval of Nevada. By signing on to this proposal, Sandoval, a popular Republican, seems to be indicating he will not support the new health plan proposed by his fellow Nevadan, Sen. Dean Heller.

Throughout the late spring and summer, insurance companies filed plans with the federal government that included proposed premiums for the health insurance plans they intend to offer in 2018. Many said they were raising rates because they weren’t certain the Trump administration would enforce the individual mandate or pay the cost-sharing subsidies.

An analysis by the consulting firm Oliver Wyman suggests that by taking action to stabilize the market, lawmakers could boost enrollment by 2 million people while cutting prices.

HELP isn’t the only Senate committee pursuing the bipartisan approach. Finance Committee leaders Orrin Hatch, R-Utah, and Ron Wyden, D-Ore., are planning two hearings in the next two weeks on insurance markets and the Children’s Health Insurance Program.

Karoun Demirjian of the Washington Post reported in July that top Trump administration officials insisted last Sunday that the odds of passing health care legislation when the Senate returns to Washington next week remain high, but others in the GOP charged that the bill’s problems require more than a quick fix.

Health and Human Services Secretary Tom Price and White House legislative affairs director Marc Short are fighting off a tide of discontent that has been exacerbated in recent days by President Donald Trump’s tweet that the Senate could simply repeal Obamacare and replace it later if it cannot pass the pending measure.

Price and Short both argued in television appearances Sunday that Trump doesn’t actually endorse the staggered approach. They said Trump was working the phones this weekend to urge senators to get on board with the Senate bill.

Still, Trump’s comment — a sharp departure from his campaign promises — is undercutting Senate Majority Leader Mitch McConnell’s efforts to collect 50 GOP votes to support the current bill. Conservative Republicans are calling for separate efforts, urging quick action to undo Obamacare to allow more time for the difficult endeavor of structuring its replacement.

Those senators are still divided, however, on whether the replacement must be devised now or sometime in the future.

“I want repeal to work, and the way you do it is you separate into two bills and you do it concurrently,” said U.S. Sen. Rand Paul, R-Kentucky, who declared on “Fox News Sunday” that “we are at an impasse” with the health care bill before the Senate.

“We should do repeal with a delay,” U.S. Sen. Ben Sasse, R-Nebraska, said on CNN Sunday, saying that he was still willing to give the Senate bill another week before declaring it dead.

In an appearance on CBS’ “Face the Nation,” U.S. Sen. Mike Lee, R-Utah, also endorsed repealing Obamacare with a “delayed implementation” that would give lawmakers time to craft a replacement, noting that approach might be “easier.”

“Sometimes when you lump too many things into one piece of legislation, you doom its chances of success,” Lee said. “That might be where we are.”

Lee is also one of the senators pushing a change to current legislation to insist that every state has at least one Obamacare-compliant insurance plan, in exchange for lifting the rules on the others. Short endorsed that change Sunday, calling it “perfectly appropriate,” and “part of the process of bringing everybody together.”

But Republicans from the other side of the party spectrum are also distancing themselves from the Senate bill, as Democrats suggest they are ready for a bipartisan approach.

After fighting Republicans tooth-and-nail for years on their plans to repeal and replace ObamaCare, Democrats have in a matter of days started touting a slew of proposals aimed at improving the ailing health care system.

The Democrats’ scramble to tackle the problem comes after Senate Republicans endured a high-profile failure on their so-called ‘skinny repeal’ replacement bill last week, leaving unclear whether Republicans can ever get the votes to go it alone on health care.

It is interesting that One House Democratic Leadership aide told Fox News that Democrats have had intentions to revamp weaknesses in ObamaCare for some time, but faced political pressure from the Obama White House.

“Democrats have always had a vision for how to fundamentally improve health care in this country whereas Republicans have spent seven years fixated on one thing: repealing it,” House Democratic Caucus Chairman Rep. Joe Crowley, D-N.Y., told Fox News.

Last week, multiple factions of the House Democratic Caucus met behind closed doors to discuss potential proposals.

Some would aim to codify cost-sharing reduction payments, lower the cost of prescription drugs, and strengthen consumer protections to ensure premium increases are stabilized, according to the aide.

Another Democratic proposal reportedly would allow people ages 50-64 to buy into Medicare.

Staffers from both the Congressional Progressive Caucus and the Congressional Black Caucus told Fox News they plan to introduce ideas as well. The CPC will focus on additional options for public health care access to address counties losing insurers; and the CBC will roll out a “mini omnibus bill” for health care, pulling together legislation from all 49 members of their caucus and focusing on “expanding community health centers.”

Meanwhile, a bipartisan group has formed in the House calling themselves “The Problem Solvers,” also eyeing potential health care fixes.

“I don’t think anyone should get too excited or too critical,” Krone said. “Just let them go talk and see what comes out of it—both parties need to have an honest discussion.”

Also this week, leaders of the Senate Health, Education, Pension & Labor Committee announced plans to begin public hearings for debate on health care starting Sept. 4, something Sen. John McCain (who helped kill the ‘skinny repeal’) suggested last week.

Despite the bipartisanship calls, one thing is clear: Democrats will never agree to conservatives’ call for an outright repeal.

“Republicans have to approach working with Democrats very cautiously because they’ve made it very clear what they plan to pursue will be difficult for Republicans to deal with,” Pye said.

He said up to this point, “Democrats haven’t offered solutions” while “Republicans have the power but can’t agree on a plan.”

Given the difficulty in locking down GOP support, some Republicans have welcomed the prospect of bipartisan talks. At the same time, some Democratic ideas — such as those that swell the deficit — may find little support on the Republican side.

But the proposals could reflect a party, like the GOP, concerned about public backlash if ObamaCare’s problems escalate into the 2018 midterm election year — amid President Trump’s warnings of a looming collapse. Insurers already are seeking big premium hikes for next year, upping the pressure on Congress to make changes.

Last week, Senate Minority Leader Charles Schumer, D-New York, asked the president to relaunch the health care push in a bipartisan fashion, declaring that Democrats are ready to work across the aisle.

Trump surrogates scoffed at that offer Sunday, with Short declaring that “Senator Schumer might talk about bipartisanship, but he has no interest in bipartisanship whatsoever.”

U.S. Sen. Bill Cassidy, R-Louisiana, used a Sunday appearance on NBC’s “Meet the Press” to hawk the health care proposal he drafted with U.S. Sen. Susan Collins, R-Maine, which they say was designed to build bipartisan support. Both have been skeptical of the current Senate bill. But on Sunday, Cassidy said he too is skeptical that Democrats are serious about cooperation.

“Until a Democrat says they are willing to sign on to the Patient Freedom Act, which allows a blue state to do what they’re doing now, but allows a red state to do something different, I’m not sure we’re ready for bipartisanship,” Cassidy said.

“Voters will take this out on both parties next year,” warned Jason Pye, vice president of legislative affairs at the conservative FreedomWorks, and I agree that both parties will take it on the chin in the up coming elections if they don’t fix what we have and stop the idiocy of working against each other.

Zero Democrats voted for the latest plan that failed in the Senate, a factor that fuels skepticism on the Republican side about calls, like that from House Minority Leader Nancy Pelosi, for “serious bipartisan conversations.”

But the former chief of staff to former Senate Minority Leader Harry Reid, D-Nev., David Krone told Fox News that Democrats are likely looking for a “new table,” so to speak.  “The table that existed was a partisan, Republican effort,” Krone said. “The loss last week by [Senate Majority Leader Mitch] McConnell showed Democrats that now is the time to find a new table—their own table—and start talking with some moderate Republicans. At least this sounds like a start, but you know that the Democrats will not tolerate the “repeal and replace”. So lets all start with both parties to discuss and come up with a health care system that works for us all.


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