Deal would re- establish health- care subsidies
WASHINGTON — Two leading senators, hoping to stabilize teetering health insurance markets under the Affordable Care Act, reached a bipartisan deal Tuesday to fund critical subsidies to insurers that President Donald Trump moved just days ago to cut off.
At the White House, virtually as the deal was being announced, Trump voiced support for it while insisting that he would move forward
to repeal President Barack Obama’s signature health law.
The plan by the senators, Republican Lamar Alexander of Tennessee and Democrat Patty Murray of Washington, would fund the subsidies for two years, a step that would provide at least short-term certainty to insurers. The subsidies, called cost-sharing reductions, go to insurance companies to offset their costs for helping low-income customers with out-of-pocket health-care expenditures such as deductibles and co-payments.
Without them, insurance companies said, premiums for all customers purchasing plans under the Affordable Care Act would shoot up, and with profits squeezed, some of the companies would likely leave the market.
“In my view, this agreement avoids chaos,” Alexander said, “and I don’t know a Democrat or a Republican who benefits from chaos.”
Trump appeared to back it, even as he berated insurance companies, declared the Affordable Care Act “virtually dead” and promised the demise of the health law in due time.
“It’ll get us over this intermediate hump,” the president said at a Rose Garden news conference, describing it as “a shortterm solution so that we don’t have this very dangerous little period.”
If approved, the deal negotiated by Alexander and Murray could provide a reprieve for the Affordable Care Act that would prevent 2018 premiums from increasing as much as they might otherwise. But consumers in many states will still face double-digit rate increases, and in many counties, health plans will be available from only one insurance company.
Moreover, Trump and other Republicans are still intent on repealing much of the Affordable Care Act, and an executive order issued last week by Trump could destabilize markets in 2019 and later years by encouraging sales of health plans that skirt the coverage requirements of the health-care law.
“For a period of one year, two years, we will have a very good solution,” Trump said. “But we’re going to have a great solution, ultimately, for health care.”
Alexander, the chairman of the Senate Health Committee, said that in addition to funding the payments to insurers, the deal would give states “more flexibility in the variety of choices they can give to consumers” — a change that should appeal to Republicans eager to give states more say over health care.
“This takes care of the next two years,” Alexander said. “After that, we can have a full-fledged debate on where we go long term on health care.”
The agreement bears the hallmarks of bipartisanship. For Republicans, state governments would find it easier to obtain waivers from certain requirements of the Affordable Care Act. But there would be explicit protections for low-income people and people with serious illnesses.
Consumers of any age would be allowed to obtain catastrophic insurance plans that typically have low monthly premiums but high deductibles and other out-of-pocket costs. Catastrophic plans provide protection against serious illnesses and injuries, but consumers must pay most routine medical expenses themselves.
Under current law, catastrophic plans are available only to people who are under the age of 30 or have received an exemption from the federal coverage requirement because they cannot afford other insurance.
For Democrats, not only would the costsharing reductions be brought back, but millions of dollars would be restored for advertising and outreach activities that publicize insurance options available in the health law’s openenrollment period, which starts next month. The Trump administration had slashed that funding.
Accusing Trump of taking steps to “sabotage health care in our country,” Murray said, “I’m really glad that Democrats and Republicans agree it’s unacceptable, and that the uncertainty and dysfunction cannot continue.”
Sen. Sherrod Brown, D-Ohio, said the deal demonstrates “exactly how the Senate should work for those we serve.” He called on leadership to take up the bill in order to stabilize the health insurance market.
Ohio’s other senator, Republican Rob Portman, was not available for comment, but Ohio Gov. John Kasich, a proponent of a bipartisan health-care solution, was pleased with the deal.
“It’s critical,” Kasich of the subsidy component, “because if you do not do that people are going to have to make choices between, you know, buying something they really need or getting health care, and the insurance companies will withdraw, which means people wouldn’t get covered.”
It remains to be seen whether conservativeleaning Republicans will get on board with the agreement, and whether the House will accept it. The Senate majority leader, Sen. Mitch McConnell of Kentucky, gave no indication on Tuesday about when — or whether — the chamber might move ahead with the plan.
A coalition of state attorneys general filed suit Friday over elimination of the cost-sharing subsidies, and Congress immediately came under pressure to take action to ensure that the payments would continue.
UnitedHealth Group Inc., the biggest U.S. health insurer, said it’s excited about the the chance to sell health plans that President Donald Trump is promoting as alternatives to Obamacare.
Last week, Trump signed an executive order promoting short-term healthinsurance plans for business owners who could band together, and tax-advantaged savings accounts that could be used to pay for health services.
For UnitedHealth, which has largely pulled out of the Affordable Care Act’s markets, it could be an opportunity and a risk. The shortterm plans have a history of consumer complaints and lawsuits, though they might appeal to people looking for lower-cost, less-comprehensive coverage.
“We have a great deal of experience in the areas covered in the order — shortterm policies, association plans and expanded use of HRAs,” Chief Executive Officer David Wichmann said.