“You have to make sure that they do what they have to do,” said Trump. “And believe me, we haven't given up on healthcare. We haven't given up on healthcare. We never give up.”
This week the Senate Health, Education, Labor and Pensions committee [HELP] heard from state insurance commissioners from around the country and five state governors on how to improve and stabilize those individual insurance marketplaces where many self-employed people buy their own insurance.
Alexander seems focused on strengthening and fixing parts of the current law. He said his committee has an ambitious goal of quickly passing a bill by the end of the month to improve the marketplaces that could affect the prices and rates for next year.
“This has been a pretty remarkable two days,” said Alexander said Thursday. He said the response from members on both sides of the aisle has been positive. “I think everyone is looking for a result, and when you're looking for result you don't try to rule things out you try to rule things in.”
Funding the federal cost-sharing subsidies or reductions (CSRs)
“If the CSRs aren't in place they're going to have to re-price those products and they're probably going to go up by some 20% which is going to be a real problem for the people who buy,” said Gov. Charlie Baker of Massachusetts, a Republican.
Republican and Democrat lawmakers alike have called for the federal government to make those payments to help stabilize the markets.
“If this committee is genuinely concerned with stabilizing the individual marketplace, the most important step it can take in the near term is ensuring funding for the CSR payments for at least the next two years,” said Montana Gov. Steve Bullock, a Democrat.
Improving enrollment through outreach
Last week, the Trump administration announced its plans to make a 90-percent cut to the advertising budget for Obamacare during the upcoming enrollment period, saying they hope it will save funds. But lawmakers say those funds are necessary to make sure young, healthy people get signed up.
Teresa Miller, the state insurance commissioner in Pennsylvania, remarked that her state is now going to do its own version of advertising and outreach in response to the cuts.
Increasing coverage in rural areas
Market instability has prompted some insurance companies to pull out of rural areas where it is costly to provide coverage to mostly low-income consumers. Many are only covered by one insurance company.
One idea proposed during the hearing comes from a plan proposed by Gov. Hickenlooper and Gov. John Kasich of Ohio. Their idea is to let rural consumers have the option of buying into the Federal Employees Health Benefit Plans.
Sen. Murkowski of Alaska was met by applause when said she supports the idea and called it a creative option that doesn’t create any additional federal programs.
Increasing state flexibility through waivers
Alexander has called for changes to Section 1332 of the Affordable Care Act, which allows states to receive waivers and to set up their own health care programs. But states have complained that the process for those waivers is slow and cumbersome.
Lawmakers said they’re looking at waiver systems in Alaska and the special high-risk pool in Maine, both of which have helped stabilize markets in those states.
“Everyone is looking at what we are doing with leading on 1332. It's not perfect but it does provide an example,” Murkowski said.Some lawmakers have suggested a “me-too” approach to approving state waivers. If one state’s waiver is approved, other states with similar waivers could have their approval expedited.
Any hope for the Graham-Cassidy plan?
Sen. Al Franken, D-MN pressed the governors about their position on the Graham-Cassidy plan, which offers block-grants of Obamacare funding to states, and was met by skepticism by the governors.
Gov. Charlie Baker, a moderate Republican who has a background in healthcare as the former CEO of Massachusetts’ Harvard Pilgrim Health Care, said he does not support the plan because it would “dramatically negatively affect” his state with cuts and that “it assumes that cost of healthcare should be the same everywhere.”
That’s something the governors and Senators reaffirmed—that solutions shouldn’t be one size fits all.