Congress returns to Washington today, September 5, 2017, and faces a formidable to-do list for the month: Acting on the Administration’s $14.55 billion emergency funding request for disaster assistance for Hurricane Harvey, funding the Federal government for Fiscal Year 2018, raising the Federal debt ceiling, reauthorizing the Children’s Health Insurance Program, reauthorizing the Federal Aviation Administration, and authorizing the Department of Defense for Fiscal Year 2018. Additionally, if congressional Republicans intend to repeal the Affordable Care Act (ACA) using the budget reconciliation process, they must do so by the end of the month. The Senate Parliamentarian ruled on September 1 that the Fiscal Year 2017 reconciliation instructions, which permit a simple majority of 51 votes to pass legislation in the Senate, expire on September 30.
President Trump has called for another repeal vote in the Senate, following the July 28 failure (by a vote of 49-51) to approve the ACA repeal and replace “skinny bill. ” While some in Congress have been working to build support for the repeal and replace plan authored by Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), and Dean Heller (R-NV), others, including Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) aim to pass an insurance stabilization bill by the end of the month. Chairman Alexander has urged the Trump Administration to continue making Cost Sharing Reduction (CSR) payments, suggesting that Congress should legislatively appropriate the money at least through 2018, and “probably should go ahead and do it through 2019. ” The HELP Committee has planned four hearings for the first two weeks of September:
September 6: Stabilizing Premiums and Helping Individuals in the Individual Insurance Market for 2018: State Insurance Commissioners
September 7: Stabilizing Premiums and Helping Individuals in the Individual Insurance Market for 2018: Governors
September 12: Stabilizing Premiums and Helping Individuals in the Individual Insurance Market for 2018: State Flexibility
September 14: Stabilizing Premiums and Helping Individuals in the Individual Insurance Market for 2018: Health Care Stakeholders
Colorado Governor John Hickenlooper (D), scheduled to testify at the September 7 hearing, is expected to make the case for a bipartisan market stabilization plan that he crafted with Ohio Governor John Kasich (R). On August 30, Kasich and Hickenlooper, joined by Governors Brian Sandoval (R-NV), Tom Wolf (D-PA), Bill Walker (I-AK), Terence McAuliffe (D-VA), John Bel Edwards (D-LA), and Steve Bullock (D-MT), sent a letter to congressional leaders outlining their plan. To stabilize the individual insurance market, the governors advocate that: (i) the Trump Administration commit to making CSR payments, and Congress appropriate CSR payments through 2019; (ii) establish a temporary stability fund to reduce premiums and limit losses for providing coverage; (iii) encourage insurance choices in underserved markets, including allowing residents in these markets to buy into the Federal Employee Benefit Program; and (4) retain the individual mandate until Congress can “devise a credible replacement. ” To increase enrollment, the governors urge continued Federal funding of outreach and enrollment efforts to increase coverage among the uninsured, which would “improve the risk pool and set in place a virtuous cycle of lower premiums leading to higher enrollment”; strengthen federal commitment to stabilize risk pools; and allow States to develop alternatives to essential health benefits (EHBs) in a way that still meets the requirements of Section 1332 State innovation waiver provisions of the ACA. To promote insurer participation in the Federal exchanges, the governors urge the Federal government to: refrain from duplicating or preempting State authority to regulate health insurance markets, support and streamline Section 1332 State innovation waivers, control costs by committing broadly to value based health care purchasing, and develop new tools to help consumers evaluate cost and quality of health care services.
Also last week, the Bipartisan Policy Center (BPC) released a proposal to stabilize individual markets. BPC’s Future of Health Care Initiative, co-chaired by former Senate Majority Leaders Tom Daschle (D-SD) and Bill Frist (R-TN), proposed an approach that includes a Health Insurance Stability Fund, CSR funding for 2018-19, modifications to the Section 1332 State innovation waiver program, expansion of Health Savings Accounts (HSAs), and development of alternatives to the individual mandate that “do not have detrimental impacts on market stability and affordability.”
As the Trump administration approaches a shortened open enrollment period for 2018, scheduled to run from November 1 through December 15, 2017, CMS announced last week it would reduce the advertising budget for open enrollment by 90 percent and would cut funding for navigators to help individuals choose health plans. Despite concerns that certain counties in the United States would be “bare” or have no health insurers participating in the ACA exchanges in 2018, ACA plans will be offered in every part of the country.
