While Senate Republicans’ efforts to overhaul the health care system failed last week, lawmakers are still working on short-term reforms, most notably to keep insurance premiums from skyrocketing next year.
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Led by Chairman Lamar Alexander, R-Tenn, the Senate Health, Labor, Education and Pensions Committee, which oversees health policy, will begin holding bipartisan hearings in September on strengthening the individual health insurance market in the very near term.
“If your house is on fire, you want to put out the fire, and the fire in this case is the individual health insurance market,” Alexander said in a statement Tuesday.
The most immediate threat to the individual market, which was established under the Affordable Care Act, is the possibility that President Trump may stop making reimbursement payments, known as cost-sharing reductions or CSRs, which help insurers them keep low-income individuals covered. The next monthly payment of the subsidies is due the third week of August.
The president tweeted over the weekend that he might withhold the critical payments, which he called “bailouts.”
If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!— Donald J. Trump (@realDonaldTrump) July 29, 2017
When asked, the White House did not comment on the possibility that Congress could limit the president's ability to end the CSRs.
Julie McPeak, the president-elect of the National Association of Insurance Commissioners and Tennessee’s insurance commissioner, told reporters Wednesday that insurance companies would likely balk at locking in rates for 2018 if they are unsure whether they’ll receive CSR payments that year.
"It's a high-anxiety issue for our insurers," she said.
State commissioners must set rates for the following year in mid-August, around the same time the CSR payments are due, in order to give insurers time to lock in contracts for the 2018 calendar year, which are due by the end of September.
“Telling those insurers who are already contractually bound to provide coverage through the rest of 2017 that CSRs won't exist makes it very, very difficult for us, as regulators, to ask them to find contracts to ante up for 2018,” McPeak said.
Sen. Alexander has said his short-term priority is for the president to approve CSR payments for the next two months and, once lawmakers return from their August recess, for Congress to pass a bill guaranteeing insurance funds for all of 2018, including CSR payments.
“It is reasonable to expect that the insurance companies would then lower their rates,” he said in his Tuesday statement.
Senators on both sides of the aisle have underscored the urgency of approving the payments simply to keep insurance rates from spiking.
"I hope the president continues to make those payments until such time as we have the opportunity to pass something that repeals the law and replaces it with something better," said Sen. John Thune, R-S.D., "But for now what we need is stability in the market place and those payments contribute to that so I would hope he'd continue to make them."
"President Trump has a big decision to make," said Sen. Claire McCaskill, D-Mo., "Is he going to sabotage the individual market by not making the payments that the law actually embraces in terms of the exchanges or is he going to let everything blow up and hurt a lot of people in the process? So, hopefully he'll make that decision soon."
Some Democrats want to go even further and make CSR payments a permanent federal government appropriation rather than a monthly payout. Sen. Jeanne Shaheen (D-NH) introduced a bill in July which would do just that, which has so far received the support of 19 other Democrats but no Republicans.
Sen. Tammy Baldwin (D-WI), who signed on to the Shaheen bill, told ABC she expects bipartisan discussions on shoring up insurance markets to continue over the August break, well before the hearings begin.
Beyond CSR payments, it’s not yet clear whether next month’s hearings will touch on broader reforms that might lead to permanent premium reductions.
McPeak said she would like to see states have more flexibility to deal with high-risk populations of patients than is currently permitted under the Affordable Care Act. She said she would be open to supporting something like a bill from Sen. Ted Cruz (R-TX) that would allow insurers to offer plans that do not cover all of the essential health benefits currently required under the ACA, but she would want even those plans to offer some mandated coverage.
But McPeak indicated that all efforts to insulate insurers from monitoring Trump’s tweets to determine policy would be a step in the right direction.
“Anything beyond month-to-month funding, which is what we're dealing with today, is going to help,” she said.