House Budget Committee Chairman and Arkansas Republican Steve Womack wants insurers to get the cost-sharing reduction (CSR) payments. He’s looking at ways to go around President Trump’s insistence that insurers not be given the CSR.
There is considerable Republican support for such a plan but getting there — budget wise — will require complex maneuvering.
Under Womack’s plan the Congressional Budget Office (CBO) will be ordered to take the CSR payments out of the baseline for projecting federal spending. That means the CBO will assume the payments are not being made.
Part two of the complex plan has Congress telling the CBO the payments might be made. The CBO will then score the payments in terms of how this will drop insurance premium rates. Lower premium rates means the CSR payments are saving the federal government money because those on ObamaCare assistance will cost less.
The maneuver is complex but doable and it allows the Republicans to fund the CSRs without having to find a budget offset to pay for the CSR.
Many conservatives are upset with the idea and call it a budget gimmick. Whether it’ll actually fly or not remains to be seen. However, it does have powerful people interested. House Speaker Paul Ryan likes the plan as long as it pays for itself via the premium reductions.
Supporters are hoping to make this part of the budget deal that must be done by March 23rd or we face another government shutdown.
As expected, Democrats like the idea and so do Republican senators Lamar Alexander of Tennessee and Susan Collins of Maine. A lot of work was done in the Senate last year to make something like this happen. However, many in the House — including North Carolina Republican Mark Walker — think this is a bailout of health insurance companies.
That apparently is a conservative no-no.
While Republicans on one end are trying to reduce health insurance rates for those on ObamaCare subsidies and for the rest of us, a coalition of 20 states have filed suit against the federal government and want ObamaCare declared unconstitutional thus null and void.
The states contend the tax reforms passed last year had a piece that says the individual mandate no longer applies. With no individual mandate, the law is not constitutional.
Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel are leading the fight. In a statement Paxton said, “The U.S. Supreme Court already admitted that an individual mandate without a tax penalty is unconstitutional. With no remaining legitimate basis for the law, it is time that Americans are finally free from the stranglehold of Obamacare, once and for all.”
The U.S. Department of Justice has not yet decided whether to defend the law.
In addition to Texas and Wisconsin, the 20 states are: Alabama, Arkansas, the PIA Western Alliance state of Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Utah and West Virginia.
And while that battle and the battle to give insurers assistance in providing insurance to ObamaCare recipients, a different group — the Center for American Progress (CAP) — says forget all this repeal talk. It wants federal health insurance expanded.
CAP calls its plan Medicare Extra for All. The idea keeps employers and health care professionals, clinics and hospitals involved in Medicare as they are now. However, it gives employers and employees the option of joining Medicare Extra.
Key word: option. No one is required to join. It’s just an option.
CAP President Neera Tanden said this differs from the single payer system proposed by former presidential candidate and Vermont Sen. Bernie Sanders. Instead of the government deciding everyone has insurance, the individual decides. The Medicare thrifty payment system will be used as a pool for working age people and families, low income people who now use Medicaid and seniors.
The flaw? Tanden does not have a cost estimate for the plan. That’s a problem says Larry Levitt of the Kaiser Foundation but the Medicare Extra is not a bad idea. He calls it a more politically and fiscally realistic roadmap for health care than full government control.
Here’s what the plan looks like:
• All U.S. citizens and residents here legally are eligible
• Under the plan preventative care, chronic disease treatment, generic prescription drugs are free
• Dental, vision and hearing services are included
• Low-income people pay no premiums or co-pays
• For everyone else premium and cost-sharing is determined according to income
• Employers can opt in or stay out and maintain their own plans
• Individuals working for employers can pick either plan — regular Medicare or Medicare Extra
• The federal government — under the plan — can negotiate prices for prescription drugs
Source links: The Hill, Associated Press, Center for American Progress, Reuters