After the spectacular failure of the Senate to repeal all or even part of Obamacare earlier this year, the Senate is now quietly getting to work on a bipartisan effort to fix the most pressing problems facing the individual insurance marketplaces.
The Senate Committee on Health, Education, Labor and Pensions will kick off two weeks of hearings tomorrow that will focus on stabilizing the individual marketplace, addressing yet another year of premium hikes around the country and expanding state flexibility on health care policy.
The senators, including Alaska’s U.S. Sen. Lisa Murkowski, won’t be at a loss for ideas.
Last week, Gov. Bill Walker signed onto a letter with seven other governors—two Republicans and five Democrats—to suggest fixes to individual marketplace that range from protecting cost-sharing reduction subsidies to giving states greater say in the operation of insurance. The letter explains there’s plenty that needs to be done, but that individual marketplaces should be the first priority.
“While rising costs are a concern throughout the system, the volatility of the individual market is the most immediate concern, threatening coverage for 22 million Americans,” said the letter. “Continuing uncertainty about the direction of federal policy is driving up premiums, eliminating competition, and leaving consumers with fewer choices.”
The group wants to see cost-sharing reduction subsidies—payments that help low-income people on the individual marketplace with out-of-pocket costs like premiums and copays—protected in the federal budget. Trump has threatened to cut off the payments. The Congressional Budget Office has estimated not making the payments would cause premiums to increase by more than 20 percent on average nationwide.
The group also wants to keep the individual mandate in place, at least for now.
“To prevent a rapid exit of additional carriers from the marketplace, Congress should leave the individual mandate in place until it can devise a credible replacement. The current mandate is unpopular, but for the time being it is perhaps the most important incentive for health people to enroll in coverage,” explains the letter. “Until Congress comes up with a better solution—or states request waivers to implement a workable alternative—the individual mandate is necessary to keep markets stable in the short term.”
Some of the major requests from the group of governors mirrors an Obamacare success story out of Alaska. Through the Obamacare waiver process, Alaska put in place a program to offer additional insurance for Alaskans with high-cost medical conditions. The program is called reinsurance and it’s expected to drop premiums in Alaska by about 21 percent next year, a substantial number given the proposed rate doesn’t count on Trump to make the additional subsidy payments mentioned above.
The governors are asking for greater flexibility for other states to put together other innovative approaches to the individual marketplace and to explore the potential for a wider reinsurance program.
Some of the governors’ suggestions are already being undercut by the Trump administration. As the group is calling for increased outreach to get more healthy people onto the marketplaces, the president is slashing funding for Obamacare outreach from $100 million to $10 million. It also announced plans to cut funding for navigators, non-government organizations that help people sign up for health care.
The Health and Human Services officials said the cut was needed because the resources were ineffective at bolstering enrollment, but new research out of Kentucky suggests otherwise. The latest research shows a downward trend in engagement and enrollment since the election of an anti-Obamacare governor and cutbacks in outreach, though the report warns that correlation does not mean causation in this case.
Hearings this week
Eight governors signed onto the letter and two—Govs. John Hickenlooper, D-Colorado, and Steve Bullock, D-Montana—are scheduled to testify to the Senate committee on Thursday.
Gov. Bill Walker didn’t get an invitation, but Alaska Division of Insurance Director Lori Wing-Heier is scheduled to participate in Wednesday’s hearing, which is scheduled to begin at 6 a.m. Alaska time. Wing-Heier was one of the key architect’s in the creation of Alaska’s reinsurance program.