Bi­par­ti­san group to work on health law

GOP voices need to plan mar­ket fix with Democrats

Northwest Arkansas Democrat-Gazette - - FRONT PAGE - COM­PILED BY DEMO­CRAT-GAZETTE STAFF

WASH­ING­TON — Even as Pres­i­dent Don­ald Trump renews his threat to un­der­mine the Pa­tient Pro­tec­tion and Af­ford­able Care Act, se­nior Repub­li­can and Demo­cratic sen­a­tors an­nounced plans Tues­day to be­gin work on a bi­par­ti­san ef­fort to sta­bi­lize the 2010 health care law.

The move — by Sen. La­mar Alexan­der, R-Tenn., chair­man of the Se­nate Health, Ed­u­ca­tion, La­bor and Pen­sions Com­mit­tee, and Sen. Patty Mur­ray, D-Wash., the com­mit­tee’s se­nior Demo­crat — does not en­sure the end of Repub­li­cans’ long-run­ning cam­paign to re­peal the Af­ford­able Care Act.

But after last week’s col­lapse

of the Se­nate GOP re­peal ef­fort, it sig­naled a new will­ing­ness by Repub­li­can sen­a­tors to be­gin work on fix­ing weak­nesses with the cur­rent law rather than try­ing to roll it back.

The ef­fort led by Alexan­der and Mur­ray will be­gin with a se­ries of hear­ings start­ing the week of Sept. 4, Alexan­der said Tues­day, an­nounc­ing his in­ter­est in pro­duc­ing leg­is­la­tion by the end of that month to “sta­bi­lize and strengthen the in­di­vid­ual health in­sur­ance mar­ket” for 2018.

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

He pub­licly urged Trump to con­tinue pay­ing sub­si­dies to health in­sur­ance com­pa­nies to off­set poor cus­tomers’ out-of-pocket med­i­cal ex­penses.

The No. 2 Se­nate Repub­li­can also sug­gested that the two par­ties should seek com­mon health care ground. Sen. John Cornyn of Texas said on the Se­nate floor, “We are forced to work to­gether to try to solve these prob­lems, and I think, frankly, bi­par­ti­san so­lu­tions tend to be more durable.”

In ad­di­tion, Se­nate Ma­jor­ity Leader Mitch McCon­nell re­buffed Trump’s de­mands that the Se­nate change its rules so it can pass a health over­haul with a sim­ple ma­jor­ity vote. McCon­nell, R-Ky., said the Se­nate lacks the votes to end fil­i­busters of leg­is­la­tion as Trump wants, and he noted that get­ting the 60 votes needed to end fil­i­busters wasn’t why Repub­li­cans lost.

“It’s pretty ob­vi­ous that our problem with health care was not the Democrats. We didn’t have 50 Repub­li­cans,” McCon­nell told re­porters, re­fer­ring to ef­forts last week not to pass bills but to move them along with a sim­ple ma­jor­ity vote.

The Se­nate health panel’s ef­fort comes as a bi­par­ti­san ef­fort in the House, where a group of Repub­li­cans and Democrats — who have called them­selves the Problem Solvers Cau­cus — has be­gun meet­ing to talk about fixes to the cur­rent 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 the Af­ford­able Care Act, rep­re­sent a small part of the U.S. health care sys­tem, with about 10 mil­lion peo­ple ob­tain­ing cov­er­age through them. But rate in­creases and the de­ci­sion by many in­sur­ers to exit mar­kets over the cur­rent po­lit­i­cal un­cer­tainty in Wash­ing­ton has threat­ened con­sumers’ ac­cess to health


Most in­de­pen­dent ex­perts, in­dus­try of­fi­cials and state reg­u­la­tors say sta­bi­liz­ing the mar­kets and con­trol­ling pre­mium in­creases could be rel­a­tively straight­for­ward. One crit­i­cal step, they say, is the con­tin­u­a­tion of pay­ing sub­si­dies to low-in­come con­sumers to help off­set their co-pay­ments and de­ductibles.

The sub­si­dies — known as cost-shar­ing re­duc­tion pay­ments — are in­cluded in the original law.

But Trump has the power to stop those pay­ments be­cause a fed­eral district judge ruled in May 2016 that Pres­i­dent Barack Obama’s ad­min­is­tra­tion was il­le­gally mak­ing the pay­ments in the ab­sence of a law ex­plic­itly pro­vid­ing money for the pur­pose.

The Obama ad­min­is­tra­tion ap­pealed the rul­ing, and the case is pend­ing be­fore the U.S. Court of Ap­peals for the District of Columbia Cir­cuit.

Now, Trump ad­min­is­tra­tion of­fi­cials are threat­en­ing to cut off the pay­ments, a threat the White House re­newed in re­cent days.

Alexan­der said Tues­day that Trump needs to ap­prove the pay­ments for Au­gust and Sep­tem­ber and that Con­gress should, “in a bi­par­ti­san way,” ap­prove a con­tin­u­a­tion of the pay­ments through 2018.

“With­out pay­ment of these cost-shar­ing re­duc­tions,” he said, “Amer­i­cans will be hurt. Up to half the states will likely have bare coun­ties with zero in­sur­ance providers of­fer­ing in­sur­ance on the ex­changes, and in­sur­ance pre­mi­ums will in­crease by roughly 20 per­cent, ac­cord­ing to America’s Health In­sur­ance Plans” — a trade group for in­sur­ers.


Alexan­der said the early Sep­tem­ber hear­ings would cover “the ac­tions Con­gress should take to sta­bi­lize and strengthen the in­di­vid­ual health in­sur­ance mar­ket so that Amer­i­cans will be able to buy in­sur­ance at af­ford­able prices in the year 2018.”

“We will hear from state in­sur­ance com­mis­sion­ers, pa­tients, gov­er­nors, health care ex­perts and in­sur­ance com­pa­nies,” Alexan­der said.

Alexan­der said the pro­posal was a nec­es­sary re­sponse to an im­mi­nent cri­sis.

“It is rea­son­able to ex­pect that if the pres­i­dent were to ap­prove con­tin­u­a­tion of cost-shar­ing sub­si­dies for Au­gust and Sep­tem­ber, and if Con­gress in Sep­tem­ber should pass a sta­bi­liza­tion plan that in­cludes cost-shar­ing for one year,” Alexan­der said, “it is rea­son­able to ex­pect that the in­sur­ance com­pa­nies

in 2018 would then lower their rates.”

Many Repub­li­cans said the ad­min­is­tra­tion should not take any steps that would harm con­sumers.

Asked if the pres­i­dent should stop mak­ing the pay­ments to in­sur­ers, Sen. John Kennedy, R-La., said: “I don’t think any­body ought to do any­thing to hurt the Amer­i­can peo­ple. Oba­macare is not work­ing. It’s bad enough on its own. Un­til we can get the thing fixed, I think we have to try to main­tain the sta­tus quo.”

The cost-shar­ing pay­ments help peo­ple with in­comes from 100 per­cent to 250 per­cent of the fed­eral poverty level — that is, about $12,060 to $30,150 a year for an in­di­vid­ual. Some Repub­li­cans say that pro­vid­ing the money would amount to “a bailout for in­sur­ance com­pa­nies,” in the words of Sen. Ted Cruz, R-Texas.

“It’s what the Democrats want,” Cruz said Tues­day. “The Democrats are the party of the big in­sur­ance com­pa­nies. The big in­sur­ance com­pa­nies have had their prof­its dou­ble un­der Oba­macare, and the only so­lu­tion the Democrats have is to give yet more bil­lions in cor­po­rate wel­fare to the in­sur­ance com­pa­nies while work­ing men and women are see­ing their pre­mi­ums sky­rocket.”

Trump used sim­i­lar lan­guage in a tweet last week that said that if the Se­nate didn’t ap­prove health care leg­is­la­tion, “BAILOUTS for In­sur­ance Com­pa­nies” would end “very soon!”

Rep. Chris Collins, R-N.Y., an ally of Trump’s in Con­gress, said on CNN on Mon­day that he had sug­gested to Trump that he end the pay­ments.

“The courts have ruled they’re il­le­gal,” Collins said. “For any­one to sug­gest that Trump would be pulling the rug out from un­der the in­di­vid­ual mar­ket­place when the fed­eral courts have ruled the pay­ments are il­le­gal — let’s fol­low the law. Let’s end them.”

While the courts work out whether the Obama health care law prop­erly ap­proved the pay­ments, law ex­perts said that end­ing the gov­ern­ment pay­ments could put Trump in a le­gal bind.

One said Trump would be hand­ing in­sur­ers a solid court case while un­der­min­ing his own lever­age to com­pel Democrats to ne­go­ti­ate, es­pe­cially if pre­mi­ums jump by 20 per­cent as ex­pected after such a move.

“Trump thinks he’s hold­ing all the cards. But Democrats

know what’s in his hand, and he’s got a pair of twos,” said Univer­sity of Michi­gan law pro­fes­sor Ni­cholas Ba­gley. Democrats “aren’t about to agree to dis­man­tle the Af­ford­able Care Act just be­cause Trump makes a reck­less bet.”

In­for­ma­tion for this ar­ti­cle was con­trib­uted by Noam N. Levey and David Lauter of Tri­bune News Ser­vice; by Robert Pear and Thomas Ka­plan of The New

York Times; and by Alan Fram and Ri­cardo Alonso-Zal­divar of The As­so­ci­ated Press.


“It’s pretty ob­vi­ous that our problem on health care was not the Democrats,” Se­nate Ma­jor­ity Leader Mitch McCon­nell said Tues­day. “We didn’t have 50 Repub­li­cans.”

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