Top takeaways from the week: 1) The Senate HELP Committee has announced plans to hold a series of hearings on market stabilization policies beginning the week of September 4; 2) the House Problem Solvers Caucus released a bipartisan set of proposals to stabilize the marketplaces; and 3) President Trump has yet to commit to continuing cost-sharing reduction payments.
After a chaotic week of failed attempts to repeal and replace the ACA, this week saw an increase in calls for bipartisanship and for immediate steps to stabilize the individual insurance markets. In a statement released after his key final vote on the “skinny bill,” Sen. McCain (R-AZ) urged, “We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of the aisle, heed the recommendations of the nation’s governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve.” Statement: http://bit.ly/2vmCC7N
Senate Action –
On Monday, Sens. Graham (R-SC), Cassidy (R-LA), and Heller (R-NV) met with President Trump to pitch their healthcare proposal, which is intended to provide states with greater flexibility with respect to Medicaid and the individual insurance markets in their states. The bill would use the Senate’s Better Care Reconciliation Act as a framework, but would aggregate federal dollars currently spent Medicaid expansion, premium tax credits, and cost-sharing reductions, and block grant it to states. Bill text: http://bit.ly/2vmJW31
However there is little support for continued action on ACA repeal and replace in the Senate at this point. Senate Finance Committee Chair Hatch (R-UT) remarked that “There’s just too much animosity and we’re too divided on healthcare,” adding that “We always have a few guys on our side that just won’t cooperate.” Sen. Thune (R-SD) noted, “Until somebody shows us a way to get that elusive 50th vote, I think it’s over. Maybe lightning will strike and something will come together, but I’m not holding my breath.” And in a nod towards potential bipartisan efforts, Sen. Blunt (R-MO) noted, “I think it’s time to move on. You can come back to health care later, though probably not with reconciliation.”
On Tuesday, Senate HELP Committee Chair Alexander (R-TN) and Ranking Member Murray (D-WA) announced that their intention to hold a series of hearings beginning the week of September 4 on “the actions Congress should take to stabilize the individual health insurance market…”. Ranking Member Alexander further elaborated that “any solution that Congress passes for a 2018 stabilization package would need to be small, bipartisan and balanced.” Press releases: http://bit.ly/2vk3zcd and http://bit.ly/2vmpX4B
And today, Senate Finance Committee Chair Hatch (R-UT) announced the Finance Committee would also hold a hearing in September, noting, “We’ve also heard a lot of demands from members of the committee for a health care hearing. I intend to do that as well shortly after the recess.” Ranking Member Wyden (D-OR) commented, “In light of the past few weeks, I’m sure members on both sides are eager to bring more health care ideas forward.”
House Action –
On Monday, the Problem Solvers Caucus, a group of 43 Republicans and Democrats led by Reps. Reed (R-NY) and Gottheimer (D-NJ), announced a bipartisan agreement to try to stabilize the individual market and to provide relief to individuals, families, and small businesses. The caucus proposed a five-point plan:
- Ensuring mandatory funding of CSR payments,
- Create a dedicated stability fund that states can use to reduce premiums and limit losses for providing coverage,
- Adjust the employer mandate by raising the threshold to business of 500 employees or more,
- Repeal the medical device tax, and
- Provide technical changes and clear guidelines for states that want to innovate on the exchange.
Press release: http://bit.ly/2vmVjbr
Administrative Action –
The Trump Administration has not yet committed to continued funding for cost-sharing reduction (CSR) payments, instead making payment decisions on a month-to-month basis. The President has also threatened to cut off CSR payments to encourage the Senate to coalesce around a repeal and replacement strategy. In fact, in the aftermath of last Friday’s final vote on an ACA repeal bill, President Trump tweeted, “As I said from the beginning, let Obamacare implode, then deal.”
However on Tuesday, Senate HELP Committee Chair Alexander urged President Trump to commit to CSR payments through September to give Congress time to craft a bipartisan stabilization plan, noting, “Without the payment of these cost-sharing reductions, Americans will be hurt.” On Wednesday the National Governors Association also weighed in, arguing “It is critically important to provide insurers and states with certainty that CSRs will be funded. Governors urge immediate action to stabilize the individual marketplace, protect consumers from rising premiums and prevent additional insurers from exiting the market.” NGA Statement: http://bit.ly/2v3oX2F
The indecision on CSR payments has created significant uncertainty for issuers as they work to finalize their rates for the upcoming plan year. The next CSR payment is expected on August 22nd, but August 16th is the deadline for insurers to make final adjustments to their rates, and they must make final decisions on whether to participate in the marketplaces by September 27. AHIP warned in a letter to Congressional leaders that premiums will rise by 20 percent if the CSRs aren’t funded. Letter: http://bit.ly/2vmyQLt
This issue is further complicated due to an ongoing court case, House v. Price. The House originally sued the Obama Administration, alleging that the Administration was making CSR payments absent Congressional appropriations. A judge ruled in favor of the House in 2016, however the Obama administration filed an appeal of that decision. After the election, the Trump Administration and Congress agreed to a stay in the case in the hopes of reconciling the issue through ACA repeal and replace.
Attorneys General from 15 States and the District of Columbia filed a motion to intervene in the case in May, arguing that the Administration was no longer representing their interests in the case. On Monday, a federal appeals court ruled for the Attorneys General, allowing them to intervene if the Trump Administration drops the appeal. Decision: http://bit.ly/2vnbGVm
Meanwhile, CMS released an updated map of projected issuer participation on the Health Insurance Exchanges in 2018 based on known issuer public announcements through August 2. Press release: http://go.cms.gov/2vmvU1o Map: http://go.cms.gov/2vmGBko