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Home Affordable Care Act Bipartisan Senate Bill Quietly Gaining Momentum

Bipartisan Senate Bill Quietly Gaining Momentum

3 minute read
by Robert Sheen

A bipartisan Senate bill that would continue cost sharing payments to insurance companies and provide states more flexibility in addressing healthcare issues is quietly gaining momentum.

The U.S. Senate’s Committee on Health, Education, Labor, and Pensions has been keeping its eye on the ball despite the continuing handwringing by President Trump and Congressional Republicans over their failure to repeal and replace the Affordable Care Act (ACA), also known by its nickname, Obamacare.

Since September, the Senate committee has been looking at ways to strike a bipartisan compromise that would continue Cost Sharing Reduction (CSR) payments to insurance companies and provide states greater flexibility in addressing their healthcare challenges. Four days of hearings were held to solicit insights from governors, state insurance officials, insurance companies and healthcare experts.

Senator Lamar Alexander (R-Tenn.), the committee chair, and the Senator Patty Murray (D-Wash.), the Ranking Member of the committee, unveiled the result the committee’s efforts this month.

Their Bipartisan Health Care Stabilization Act provides the following:

A two-year extension of CSR payments to insurance companies providing health insurance policies on government healthcare exchanges. These payments subsidize the cost of co-payments and deductibles for lower-income people.

Greater flexibility to states in developing solutions to their healthcare challenges by making changes to the ACA’s state innovation waiver process.

Requires many insurers to pay rebates to individuals and the federal government related to premiums in the nongroup health insurance market for 2018. It is estimated that the federal government would receive rebates from insurers totaling about $3.1 billion over the 2018-2027 period.

Allows anyone in the nongroup market to purchase a catastrophic plan, beginning in 2019.

The U. S. Department of Health and Human Services (HHS) would be required to spend $105.8 million of those existing user fees for outreach and enrollment activities related to the federally-facilitated marketplace for each of plan years 2018 and 2019. That amount is higher than the amount the Administration has previously announced it plans to spend on those activities for the 2018 plan year and restores a good amount of the funding cuts to marketplace outreach and enrollment assistance made by the White House.

The Congressional Budget Office (CBO) has reviewed the proposed legislation, finding as follows:

“On net, CBO and the staff of the Joint Committee on Taxation (JCT) estimate that implementing the legislation would reduce the deficit by $3.8 billion over the 2018-2027 period relative to CBO’s baseline. The agencies estimate that the legislation would not substantially change the number of people with health insurance coverage, on net, compared with that baseline projection. Enacting the legislation would affect direct spending and revenues; therefore, pay-as-you-go procedures apply. CBO and JCT estimate that enacting the legislation would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2028.”

The CBO expects that federal costs in 2018 would be higher with funding for CSR payments because premiums for 2018 have already been finalized by insurers. However, the CBO projects that if the legislation passes and the subsidies were paid, insurers would repay $3.1 billion in rebates to individuals and the government, to account for premium hikes originally designed to cover those costs. Premiums in 2019 would be lower with funding for CSR payments than without it, and federal costs would probably be lower as well, the CBO concluded.

A CBO report released in August had said not funding CSR payments would increase the federal deficit by $194 billion through 2026.

Despite inconsistent comments from President Trump, who first supported the compromise and then apparently changed his mind, and opposition from Paul Ryan, the Speaker of the U.S. House of Representatives, Senators Alexander and Murray have quietly pressed forward.

The bill has garnered bipartisan support from 24 U.S. Senators, divided evenly among Republicans and Democrats, and 10 governors. A significant endorsement came on Friday from 18 patient, provider, and consumer groups, including AARP, the Cystic Fibrosis Foundation, the American Heart Association and the American Diabetes Association.

Senator Alexander said he believes President Trump will end up supporting the bill. “The president doesn’t want to ‘bail out’ insurance companies. We agree, as does Sen. Patty Murray, the lead Democratic negotiator. This week CBO affirmed that our cost-sharing proposal benefits taxpayers and low-income policyholders, not insurers,” wrote the Senator in an op-ed. “The president doesn’t want Americans to be hurt more before ObamaCare is replaced. CBO says without cost-sharing they will be: Premiums would rise and insurers would flee collapsing markets, leaving up to 16 million Americans without options. Such chaos would be a four-lane highway to single-payer insurance, a gift to Sen. Bernie Sanders. That’s why House Republicans’ repeal-and-replace bill continued cost-sharing for two years.”

The importance of passing the legislation for those who support continued CSR payments was underscored last week when a federal judge in California denied a request for an emergency ruling that would have forced the Trump Administration to continue making payments to health insurers. The request from 18 states required the Trump Administration to continue making the payments while a lawsuit challenging the legality of the Administration’s cancellation of CSR payments was reviewed by the court. Previous rulings supported the assertation that the CSR payments were being made illegally because they had never received authorization from Congress.

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Bipartisan Senate Bill Quietly Gaining Momentum
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Bipartisan Senate Bill Quietly Gaining Momentum
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A bipartisan Senate bill that would continue cost sharing payments to insurance companies and provide states more flexibility in addressing healthcare issues is quietly gaining momentum.
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The ACA Times
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