Top Takeaways from Recess – (1) The Senate HELP Committee has scheduled a series of hearings over the next two weeks to discuss market stabilization policies, (2) Governors Hickenlooper (D-CO) and Kasich (R-OH) sent a bipartisan letter to Congressional leadership outlining their priorities for market stabilization, and (3) the Administration announced it would cut spending on Marketplace outreach by 90%.

As Congress returns from their August recess next week, it will resume its efforts to reform the ACA, albeit with a far more narrow focus: stabilization of the individual health insurance marketplaces, rather than renewing its attempts to repeal and replace the ACA and implement large-scale Medicaid reform. Democrats have continued to urge the Administration to commit to fully administering and enforcing the ACA, while States and other stakeholders have called on Congress to pass legislation that would provide permanent funding for cost-sharing reduction payments, establish a permanent reinsurance program, and to expand the use of 1332 waivers in the hopes of stabilizing the ACA’s marketplaces.

Congressional Activity –

Senate HELP Committee Chair Alexander (R-TN) and Ranking Member Murray (D-WA) have announced four hearings over the next two weeks to address market stabilization policy. The Committee will hear from State Insurance Commissioners, Governors, and other stakeholders in order to gain a wide range of perspectives on how to move forward. Press releases: and

Meanwhile, Democrats have continued to push the Administration to enforce the ACA and to commit to a robust open enrollment this fall:

  • On August 14, House Committee on Energy & Commerce Ranking Member Pallone (D-NJ) and House Ways & Means Committee Ranking Member Neal (D-MA) sent a letter to the Government Accountability Office (GAO) urging the agency to investigate the Administration’s enforcement of the ACA’s individual mandate. Press release: Letter:
  • Also on August 15, Senate HELP Committee Ranking Member Murray (D-WA) and 15 Senate Democrats sent a letter to HHS Secretary Price requesting information on his plans for enforcement of section 1557 of the ACA, which prohibits discrimination on health care on the basis of race, color, national origin, sec, age, and disability. Press release: Letter:
  • On August 17, the Congressional Hispanic Caucus sent a letter to HHS Secretary Price urging HHS to prioritize Latino outreach and enrollment efforts. Press release with text of letter:
  • Also on August 17, House Committee on Energy & Commerce Ranking Member Pallone (D-NJ), House Committee on Ways & Means Ranking Member Neal (D-MA), Senate HELP Committee Murray (D-WA), Senate Finance Committee Ranking Member Wyden (D-OR), and Senate Aging Committee Ranking Member Casey (D-PA) sent a letter to HHS Secretary Price and CMS Administrator Verma raising concerns over perceived attempts to undermine the ACA’s Marketplaces and requesting a briefing on the Administration’s preparation for the upcoming Open Enrollment season. Press release: Letter:

State Activity –

Governors and several state-based Marketplaces have sent letters urging Congress to take steps to address market stability:

  • On August 9, New Hampshire Governor Sununu sent a letter to President Trump urging him to provide a clear roadmap to Congress on ACA reform, commit to funding cost-sharing reductions in 2017 and 2018, commit funds to stabilizing state markets, and provide carriers and states additional time to file 2018 rates. Letter:
  • On August 29, the leaders of 12 state-based exchanges wrote a letter to Senate HELP Committee Chair Alexander (R-TN) and Ranking Member Murray (D-WA) urging them to consider consistent funding of cost-sharing reduction payments, to establish a permanent, federal reinsurance program, to maintain flexibility over the use of 1332 waivers, and to promote stability through a commitment to certainty and long-term solutions to market stabilization. Letter:
  • On August 30, Governors Hickenlooper (D-CO), Kasich (R-OH), Bullock (D-MT), McAuliffe (D-VA), Bel Edwards (D-LA), Wolf (D-PA), Walker (I-AK), and Sandoval (R-NV) sent a letter to House Speaker Ryan (R-WI), Minority Leader Pelosi (D-CA), Senate Majority Leader McConnell (R-KY) and Minority Leader Schumer (D-NY) urging them to take immediate steps to make coverage more stable and affordable, through “(1) immediate federal action to stabilize markets, (2) responsible reforms that preserve the recent coverage gains and control costs, and (3) an active federal/state partnership that is based on innovation and a shared commitment to improve overall health system performance.” Letter:

Meanwhile, Iowa submitted a final 1332 demonstration waiver to CMS for approval on August 22; the waiver would redistribute the estimated subsidies allocated to the state in 2018 between a reinsurance program and per-member-per-month premium credits adjusted based on age and income. Waiver:

Administration Activity –

On August 10, CMS announced the delay of a final deadline for health insurance issuers to submit their final rates for the 2018 plan year to September 5. This new delayed date provides issuers with more time to assess how the policy landscape will impact their 2018 rates. Guidance:

However, despite this additional time, the Administration has not yet committed to ongoing payments for cost-sharing reduction (CSR) payments to issues, largely regarded as one of the main factors driving uncertainty in setting premium rates across the country. The Administration agreed to pay issuers for the month of August, and has said it would decide on payments on a month-to-month basis.

On August 15, the Congressional Budget Office (CBO) released an analysis on the effects of terminating CSR payments, finding that doing so would cause premiums to increase by 20 percent in 2018, and would increase the deficit by $194 billion over a decade. Analysis:

Meanwhile, yesterday CMS posted an update to its Health Insurance Exchanges Issuer County Map, which shows that now every county is projected to have at least one issuer offer coverage through the health care marketplaces, and that 1,476 counties are projected to have 1 issuer in 2018. Press release:

Today, the Administration announced its intention to cut back on outreach and enrollment efforts for the upcoming open enrollment season, pledging to spend only $10 million on advertising for the 2018 enrollment season, a 90 percent cut from 2017. It also announced its plans to cut funding to ACA Navigators by about half.