Bi­par­ti­san health fixes gain steam

Northwest Arkansas Democrat-Gazette - - FRONT PAGE - In­for­ma­tion for this ar­ti­cle was contributed by Ben Brody, Mark Ni­quette and Pa­tri­cia Laya of Bloomberg News; by Amy Gold­stein and Paige Win­field Cun­ning­ham of The Wash­ing­ton Post; and by Ri­cardo Alonso-Zaldivar of The As­so­ci­ated Press.

Se­nate Repub­li­cans in­creas­ingly are ex­press­ing a will­ing­ness to con­sider a bi­par­ti­san ap­proach to strength­en­ing the in­di­vid­ual in­sur­ance mar­ket un­der the Pa­tient Pro­tec­tion and Af­ford­able Care Act, even as Pres­i­dent Don­ald Trump is de­cid­ing whether to end pay­ments for it.

“We have got a desta­bi­lized mar­ket where in­sur­ance rates are go­ing to go up 20, 30, 40 per­cent next year,” Sen. Thom Til­lis, R-N.C., said Sun­day on ABC’s This Week. “Any­thing that we can do to pre­vent

that and the dam­age that that will have on peo­ple who need health care, I think is some­thing I have to look at.”

The Se­nate health com­mit­tee plans to be­gin bi­par­ti­san hear­ings early next month with the goal of sta­bi­liz­ing the in­di­vid­ual in­sur­ance mar­ket, the com­mit­tee’s Repub­li­can chair­man, La­mar Alexan­der of Ten­nessee, and top Demo­crat, Patty Mur­ray of Wash­ing­ton, an­nounced last week.

At is­sue now is the pay­ments, called cost-shar­ing re­duc­tions, which help in­sur­ers off­set health care costs for low-in­come Amer­i­cans. Trump has re­peat­edly sug­gested end­ing the pay­ments as a bar­gain­ing tac­tic to bring Democrats to the ne­go­ti­at­ing ta­ble as Repub­li­can ef­forts to re­peal and re­place the Af­ford­able Care Act have stalled.

The sub­si­dies are called for in the 2010 health care law, but they are un­der a legal cloud be­cause of a law­suit brought by House Repub­li­cans, who ques­tioned whether the law in­cluded a spe­cific in­struc­tion for the gov­ern­ment to pay the money. The case is on hold be­fore a fed­eral ap­peals court; the ad­min­is­tra­tion has con­tin­ued mak­ing monthly pay­ments in the mean­time.

“The cost-shar­ing re­duc­tions over time need to be elim­i­nated,” Til­lis said. “But we can’t just all of the sud­den pull the rug out from un­der­neath an in­dus­try that has had this in place for about seven years.”

Se­nate Ma­jor­ity Leader Mitch McCon­nell said Satur­day that he’d be open to the bi­par­ti­san at­tempt. He also said there was “still a chance” to re­vive the ef­fort to re­place the cur­rent health care law — but that it was quickly be­com­ing un­likely.

After the Se­nate’s GOP health care pro­posal failed in a vote last month, the pres­i­dent sent out a se­ries of tweets in which he seemed to threaten to stop the pay­ments.

“If a new Health­Care Bill is not ap­proved quickly, BAILOUTS for In­sur­ance Com­pa­nies…will end very soon!” said one of Trump’s Twit­ter mes­sages.

Ex­perts say the money is not a bailout, but rather a gov­ern­ment obli­ga­tion. With­out a subsidy guar­an­tee from Trump, some in­sur­ers have been seek­ing dou­ble-digit pre­mium in­creases, on top of raises that re­flect un­der­ly­ing med­i­cal costs.

The next pay­ment is due Aug. 21.

Ap­pear­ing to­gether on CBS’ Face the Na­tion on Sun­day, Gov. John Ka­sich, R-Ohio, and Gov. John Hick­en­looper, D-Colo., said both par­ties should work to find a so­lu­tion.

“Repub­li­cans are go­ing to have to ad­mit that there is a group of peo­ple out there who will need help,” Ka­sich said.

“I think we’ll be sur­prised at the num­ber of sen­a­tors that are will­ing to kind of step back and say, ‘All right. Let’s roll up our sleeves and work on a bi­par­ti­san ba­sis and see how far we can go,”’ Hick­en­looper said.

Sen. Ron John­son, R-Wis., said “we do need to sta­bi­lize those mar­kets” but urged his col­leagues to move on to other pri­or­i­ties.

“I re­ally do think we prob­a­bly ought to turn our at­ten­tion to debt ceil­ing and fund­ing the gov­ern­ment and tax cuts un­til we can re­ally get all the par­ties to­gether,” John­son said Sun­day on CNN’s State of the Union.

MIXED MES­SAGES

With the next sign-up pe­riod for in­sur­ance ex­changes less than three months away, the gov­ern­ment ap­pears to be op­er­at­ing on con­tra­dic­tory tracks, ac­cord­ing to in­sur­ers, state in­sur­ance com­mis­sion­ers, health pol­icy ex­perts and lead­ers of grass-roots groups that have worked to en­roll con­sumers who now have cov­er­age un­der the Af­ford­able Care Act.

Trump con­tin­ues to talk of peo­ple he terms “Oba­macare vic­tims,” and the Health and Hu­man Ser­vices Depart­ment is is­su­ing weekly maps show­ing the few dozen coun­ties that might lack a health plan on the ex­changes for next year.

Yet many lay­ers down in the gov­ern­ment, the part of the Health and Hu­man Ser­vices Depart­ment that di­rectly over­sees the law’s in­sur­ance mar­ket­places and the fed­eral health­care.gov en­roll­ment web­site has been car­ry­ing out much, if not all, of its reg­u­lar work — in­clud­ing con­ven­ing its an­nual meet­ing in June with “nav­i­ga­tors” who help steer con­sumers to­ward health plans and telling them at the time that the sub­si­dies would con­tinue, ac­cord­ing to three par­tic­i­pants.

Julie McPeak, Ten­nessee’s in­sur­ance com­mis­sioner and the in­com­ing pres­i­dent of the Na­tional As­so­ci­a­tion of In­sur­ance Com­mis­sion­ers, said she and col­leagues have con­tacted of­fi­cials at the Depart­ment of Health and Hu­man Ser­vices, the Jus­tice Depart­ment, the White House’s in­ter­gov­ern­men­tal af­fairs of­fice, and the Of­fice of Man­age­ment and Bud­get, try­ing to learn which part of the gov­ern­ment would make the de­ci­sion about the cost-shar­ing pay­ments and when such a de­ci­sion could be ex­pected.

“And we can’t get a clear pic­ture,” McPeak said.

As a re­sult, she noted, Ten­nessee can­not plan its own out­reach ef­forts be­cause it is im­pos­si­ble to pro­vide con­sumers ac­cu­rate in­for­ma­tion about in­sur­ance prices and choices for the com­ing year.

Of­fi­cials at the June meet­ing pro­vided no as­sur­ances about whether the ad­min­is­tra­tion would con­tinue the gov­ern­ment’s usual en­roll­ment ac­tiv­i­ties or pro­mo­tion. In Jan­uary, Trump halted most ad­ver­tis­ing aimed at en­cour­ag­ing con­sumers to sign up be­fore the dead­line for 2017 cov­er­age.

Health and Hu­man Ser­vices Sec­re­tary Tom Price so far has sent mixed sig­nals. His depart­ment re­cently can­celed con­tracts with two com­pa­nies that have helped thou­sands of Amer­i­cans in 18 cities find health plans un­der the law. The sus­pen­sion of the $22 mil­lion con­tracts ends en­roll­ment fairs and in­sur­ance sign-ups in pub­lic li­braries.

But the depart­ment did work with Alaska on a waiver that’s been praised for help­ing to sta­bi­lize that state’s in­sur­ance mar­ket. And the agency is­sued a reg­u­la­tion that made sev­eral changes in­sur­ers had re­quested to help things run more smoothly.

About 10 mil­lion peo­ple are signed up for pri­vate in­sur­ance in sub­si­dized mar­kets, and 11 mil­lion more have cov­er­age through Medicaid ex­pan­sions.

Mike Leav­itt, a health care con­sul­tant and for­mer Utah gov­er­nor who served as Health and Hu­man Ser­vices sec­re­tary un­der Pres­i­dent Ge­orge W. Bush, pre­dicted that the two con­tracts cut last month — with the north­ern Vir­ginia-based com­pa­nies Cog­nosante and CSRA — will not be the last to go.

Still, Leav­itt pre­dicted the ad­min­is­tra­tion is un­likely to back away en­tirely from its role in the mar­ket­places in Trump’s first year in of­fice. “If you are the sec­re­tary of health, you don’t want to buy your­self a huge mess at the end of the year … by cre­at­ing such an abrupt shift that the ad­min­is­tra­tion gets that blame,” he said.

AP/ADAM BEAM

Se­nate Ma­jor­ity Leader Mitch McCon­nell at­tends the Graves County Repub­li­can Break­fast in May­field, Ky., on Satur­day. McCon­nell said Satur­day that he was open to a bi­par­ti­san ef­fort to im­prove the health care law, but he also said there was “still a chance” to re­peal and re­place the cur­rent law.

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