The Atlanta Journal-Constitution
WHAT’S NEXT
Some Republicans, Dems want to keep subsidies for now.
Republicans are reaching out to Democrats for a joint effort to shore up insurance markets, days after the GOP effort to undo the health care law collapsed,
WASHINGTON — Republicans on both sides of the Capitol scrambled Tuesday to defuse President Donald Trump’s threat to cut off critical health insurance payments, moving around the president toward bipartisan legislation to shore up the Affordable Care Act.
Sen. Lamar Alexander, R-Tenn., the influential chairman of the Senate Health, Education, Labor and Pensions Committee, announced Tuesday that his panel will begin work in early September on legislation to “stabilize and strengthen the individual health insurance market” for 2018.
He publicly urged Trump to continue paying subsidies to health insurance companies to offset poor customers’ out-of-pocket medical expenses as work proceeds.
Alexander’s announcement was the first tangible indication of cooperation between the parties since Republican efforts to scrap the Affordable Care Act collapsed in the Senate last week. It was followed just minutes later by a pledge from a bipartisan group of House members to cooperate on health care legislation of their own.
Trump has repeatedly threatened to cut off the subsidies, known as cost-sharing reduction payments, which reimburse insurers for cutting deductibles and other out-of-pocket costs for millions of low-income people.
Alexander said it was important for Trump to approve the payments for August and September, and that Congress should “in a bipartisan way” approve a further 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.
Sen. Patty Murray of Washington, the senior Democrat on the committee, welcomed Alexander’s statement.
Alexander said the committee would hold hearings starting the week of Sept. 4 “on 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 at a confirmation hearing for five of Trump’s nominees for jobs at the Department of Health and Human Services.
Alexander said his proposal was a necessary response to an imminent crisis.
“In my opinion,” Alexander said, “any solution that Congress passes for a 2018 stabilization package would need to be small, bipartisan and balanced. It should include funding for the cost-sharing reductions, but it also should include greater flexibility for states in approving health insurance policies.”
“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.”
Payment of the cost-sharing subsidies is a top priority for insurers and for Democrats in Congress, who say that cutting off the payments would cause havoc in insurance markets.
The president has the power to stop the payments because a federal district judge ruled in May 2016 that the Obama 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.
House Republicans, who filed suit to stop the payments in late 2014, and the Trump administration have told the court, in a joint report, that they are discussing “measures that would obviate the need for judicial determination of this appeal, including potential legislative action.”
Alexander said he hoped Congress would eventually approve long-term measures to create a more robust market for people who buy health insurance on their own.
But first, he said, “we need to put out the fire in these collapsing markets, wherever these markets are, and I think it is reasonable for the president to do that for two months and then for us to act during the month of September.”
Many Republicans say 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). But some Republicans say that providing the money would amount to “a bailout for insurance companies,” in the words of Sen. Ted Cruz, R-Texas.
Rep. Chris Collins, R-N.Y., a top 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.”