A bi­par­ti­san ef­fort to fix health­care

Se­nior sen­a­tors seek to sta­bi­lize, not roll back, Obama’s sys­tem.

Los Angeles Times - - FRONT PAGE - By Noam N. Levey and David Lauter

WASH­ING­TON — Even as Pres­i­dent Trump re­news his threat to un­der­mine the Af­ford­able Care Act, se­nior Repub­li­can and Demo­cratic sen­a­tors an­nounced plans Tues­day to be­gin work on a new bi­par­ti­san ef­fort to sta­bi­lize the 2010 health­care law, of­ten called Oba­macare.

The move — by Se­nate Health Com­mit­tee Chair­man Lamar Alexan­der (RTenn.) and Sen. Patty Mur­ray (D-Wash.), the com­mit­tee’s se­nior Demo­crat — does not en­sure the end of the GOP’s long Oba­macare re­peal cam­paign.

But in the wake of last week’s dra­matic col­lapse of the Se­nate GOP re­peal ef­fort, it sig­naled a new will­ing­ness by Repub­li­can sen­a­tors to be­gin work on fix­ing weak­nesses in the cur­rent law rather than try­ing to roll it back.

Se­nate Ma­jor­ity Leader Mitch Mc­Connell (R-Ky.) un­der­scored that mes­sage Tues­day in a state­ment and a se­ries of mes­sages on Twit­ter in which he set out the sched­ule for the Se­nate for the rest of Au­gust.

On the list was con­firm-

ing nom­i­nees, leg­is­la­tion to help veter­ans and the reau­tho­riza­tion of user fees that pay for a large chunk of the Food and Drug Ad­min­is­tra­tion. No­tably miss­ing was health­care.

The ef­fort by Alexan­der and Mur­ray will be­gin with a se­ries of hear­ings start­ing the week of Sept. 4, Alexan­der said Tues­day, an­nounc­ing his in­ter­est in fin­ish­ing leg­is­la­tion by the end of the month to head off po­ten­tially large in­sur­ance rate hikes for 2018.

“Any so­lu­tion that Congress passes for a 2018 sta­bi­liza­tion pack­age would need to be small, bi­par­ti­san and bal­anced,” he said as he in­vited the com­mit­tee’s Democrats to par­tic­i­pate in the process.

The Se­nate hear­ings could com­ple­ment a bi­par­ti­san ef­fort in the House, where a group of Re­pub­li­cans and Democrats — who have called them­selves the Prob­lem Solvers Cau­cus — have be­gun meet­ing to talk about fixes to the law.

Most pa­tient ad­vo­cates, physi­cian groups, hos­pi­tals and even many health in­sur­ers have been say­ing for months that tar­geted fixes to in­sur­ance mar­ket­places make more sense than the kind of far-reach­ing over­haul of gov­ern­ment health pro­grams that Re­pub­li­cans had been push­ing.

The mar­ket­places, though a pil­lar of Oba­macare, rep­re­sent a small part of the U.S. health­care sys­tem with just about 10 mil­lion peo­ple get­ting cov­er­age there.

But rate hikes and the de­ci­sion by many in­sur­ers to exit mar­kets amid the cur­rent po­lit­i­cal un­cer­tainty in Wash­ing­ton has threat­ened con­sumers’ ac­cess to health plans.

Most in­de­pen­dent ex­perts, in­dus­try of­fi­cials and state reg­u­la­tors say sta­bi­liz­ing the mar­kets and con­trol­ling premium hikes would ac­tu­ally be rel­a­tively straight­for­ward.

One crit­i­cal step is fund­ing as­sis­tance through Oba­macare to low-in­come con­sumers to help off­set their co-pays and de­ductibles.

This aid — known as cost­shar­ing re­duc­tion, or CSR, pay­ments — was in­cluded in the orig­i­nal law.

But the pay­ments have be­come a po­lit­i­cal foot­ball as Re­pub­li­cans dur­ing the Obama ad­min­is­tra­tion suc­cess­fully ar­gued in fed­eral court that the aid can’t be pro­vided with­out an ap­pro­pri­a­tion by Congress. That rul­ing has been on hold for months.

Now Trump ad­min­is­tra­tion of­fi­cials are threat­en­ing to cut off the pay­ments, a threat the White House re­newed af­ter last week’s Se­nate votes.

Congress could sim­ply put an end to that un­cer­tainty by vot­ing to ap­pro­pri­ate the CSR money, an idea sup­ported by many law­mak­ers.

Alexan­der said Tues­day that he asked the pres­i­dent to con­tinue fund­ing the CSR pay­ments for Au­gust and Septem­ber to give Congress time to ap­pro­pri­ate the money go­ing for­ward.

Sup­port­ers of con­tin­u­ing the pay­ments got a boost late Tues­day when a fed­eral ap­peals court in Wash­ing­ton al­lowed Demo­cratic state at­tor­neys gen­eral to join the con­tin­u­ing court ar­gu­ments over the money.

Now that the at­tor­neys gen­eral are for­mally in the case, they would be able to quickly go to court to de­fend the pay­ments if the ad­min­is­tra­tion tried to cut them off.

Most in­sur­ance ex­perts and of­fi­cials also say the gov­ern­ment must cre­ate a bet­ter sys­tem to pro­tect in­sur­ers from big losses if they are hit with very costly pa­tients. Such rein­sur­ance sys­tems are al­ready used in other in­sur­ance mar­ket­places, such as the Medi­care Part D pre­scrip­tion drug pro­gram, and are seen as crit­i­cal to sta­bi­liz­ing mar­kets.

Whether enough con­gres­sional Re­pub­li­cans will ul­ti­mately back such an ef­fort to sta­bi­lize in­sur­ance mar­kets re­mains un­clear.

Many GOP law­mak­ers con­tinue to be in­ter­ested in rolling back Oba­macare and dra­mat­i­cally cut­ting fund­ing for health­care safety-net pro­grams such as Med­i­caid.

Three Se­nate Re­pub­li­cans — Bill Cas­sidy of Louisiana, Lind­sey Gra­ham of South Carolina and Dean Heller of Nevada — have been talk­ing about a whole new re­peal plan with the White House in re­cent days.

And Tues­day, Sen. Mike Rounds (R-S.D.) warned that many Re­pub­li­cans are un­likely to vote for a bill that sim­ply com­mits more fed­eral money to Oba­macare in­sur­ance mar­kets.

But the ap­petite for a new re­peal push seems lim­ited among GOP con­gres­sional lead­ers at the mo­ment.

And Re­pub­li­cans face mount­ing po­lit­i­cal pres­sure not to let the cur­rent law col­lapse. Polls in­di­cate that Amer­i­cans now hold con­gres­sional Re­pub­li­cans and the Trump ad­min­is­tra­tion re­spon­si­ble for the fate of the na­tion’s health­care sys­tem, in­clud­ing the in­sur­ance mar­ket­places.

“There’s just too much an­i­mos­ity and we’re too di­vided on health­care,” Sen. Or­rin G. Hatch (R-Utah), the head of the Se­nate Fi­nance Com­mit­tee, said of the fu­ture prospects of re­peal in an in­ter­view Mon­day with Reuters.

“I think we ought to ac­knowl­edge that we can come back to health­care af­ter­ward, but we need to move ahead on tax re­form,” Hatch said.

His re­marks were quickly fol­lowed by oth­ers in GOP lead­er­ship po­si­tions.

“I think it’s time to move on to some­thing else,” Sen. Roy Blunt of Missouri told CNN. “If the ques­tion is do I think we should stay on health­care un­til we get it done, I think it’s time to move on to some­thing else.”

Sen. John Thune of South Dakota also chimed in. “Un­til some­one shows us how to get that elu­sive 50th vote, I think it’s over,” he told re­porters.

The re­marks seemed a co­or­di­nated ef­fort to re­spond to ad­min­is­tra­tion of­fi­cials who said over the week­end that they wanted the Se­nate to keep work­ing on health­care.

And few GOP sen­a­tors ap­pear to sup­port Trump’s threats to cut off the CSR pay­ments, which could send in­sur­ance pre­mi­ums sky­rock­et­ing. A grow­ing num­ber of Repub­li­can law­mak­ers has called on Trump to not stop the pay­ments.

Pho­to­graphs by Chip So­mod­ev­illa Getty Im­ages

THE EF­FORT by Patty Mur­ray, right, the Se­nate Health Com­mit­tee’s se­nior Demo­crat, and Lamar Alexan­der is to be­gin with hear­ings in early Septem­ber.

SEN. LAMAR ALEXAN­DER (R-Tenn.) says he wants to fin­ish health­care leg­is­la­tion in Septem­ber to head off po­ten­tially large in­sur­ance rate hikes for 2018.

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