The U.S. Senate is now going to work on the repeal and replacement — maybe — of the Affordable Care Act. The House’s American Health Care Act (AHCA) is pretty much dead on arrival. While some parts of the House plan will survive, a lot of it will have to change.
Republicans also must find a way around a potential — but very likely — filibuster.
And while both political parties pose and posture, insurance commissioners in state after state are doing all they can to keep the few insurers participating in the ObamaCare exchanges in the game. To do it they are offering new — and never heard of before — incentives to stick with it for another year.
Insurers meanwhile continue to look to Washington and at Congress and the Trump administration for some sign of what they should do. They’re not sure if the Trump administration is going to continue to subsidize the out-of-pocket costs for lower-income households.
That’s a deal-breaker for most.
On the table is $7 billion that will help keep insurers participating. The president has said yes to the money but has made no move in that direction. That has insurance commissioners extending rating filing deadlines and giving other concessions that would not be the normal order of business.
John Franchini is the insurance commissioner of the PIA Western Alliance state of New Mexico. He said, “As a regulator, instead of being rigid on timelines, the type of pricing I’m going to want, I’m being more open about this. I’m trying to be more flexible to give them confidence that if things change, we as regulators will be flexible with them.”
In California — also a PIA Western Alliance state — commissioner Dave Jones has let insurers submit two different sets of rate requests. One is if ObamaCare continues and the other if it goes away. “Based on what we were hearing from insurers, we anticipated Trump rates would be double-digit increases over the past year. I wanted to give insurers the opportunity to file rates based on Trump,” Jones said.
In the PIA Western Alliance state of Washington Insurance Commissioner Mike Kreidler said he’s thinking of following Alaska’s lead and developing a reinsurance program that is a mix of state and federal money to help subsidize insurers. However, Kreidler said, “I don’t have any leverage to tell a health insurer they have to stay in the market. The GOP is scaring the bejesus out of them, and I’m trying to calm things down and work it out.”
House Ways and Means Chairman and Texas Republican Rep. Kevin Brady said the administration needs to make those payments to keep insurers involved. “We should act within our constitutional authority now to temporarily and legally fund Cost Sharing Reduction payments as we move away from ObamaCare and toward a patient-centered system that truly works for the American people,” Brady said.
Republicans — upon the election of Donald Trump — said they’d immediately repeal and replace ObamaCare. The self-imposed deadline at that time passed about two months ago. In other words, it’s kind of a mess.
Senate Majority Leader Mitch McConnell has vowed to take a vote on something by the end of July before the annual August recess but what that something will look like is anybody’s guess. And McConnell and others in Republican leadership admit that it is going to be hard to get enough votes to pass reforms.
A sort of a plan was put forth last week and it is already raising hackles on hardcore conservative Republicans and on the more moderate of the party. The issues range from preexisting conditions to essential health benefits and a plan to let states dump them to allowing states to repeal all ObamaCare regulations.
And then there’s Medicaid and what to do with it.
Part of the problem is there are four groups vying for control. A task force of 13 men started the process but criticism that no women are involved led the group to open its planning to any senators wanting to come.
Then there’s the group led by Louisiana Republican Sen. Bill Cassidy and Maine Republican Sen. Susan Collins. They have blasted the House’s American Health Care Act and crafted a plan of their own called the Patient Freedom Act.
A conservative group led by Ohio Republican Sen. Rob Portman is completely focused on Medicaid expansion.
The last group is made up of ultra-conservatives led by Texas Republican Sen. Ted Cruz and Utah Republican Sen. Mike Lee. They want whatever the Senate does to be as close as possible to the House bill.
In what may be bad news for employers, some Republicans want to tax employer-sponsored health insurance plans to help support and stabilize the public health insurance market. As it stands today, those plans aren’t taxed but the tax-favored status of employer-sponsored insurance cost the federal government $250 million in 2016.
Taxing that insurance could affect 177 million employees around the country.
Joel Wood does government affairs for the Council of Insurance Agents & Brokers (CIAB). His group is totally opposed to the idea. “I’m not saying we feel naked, but we feel vulnerable. All we are trying to do is keep that drumbeat going on whatever Congress decides to do to resolve issues associated with exchanges, high risk pools, Medicaid. [We want to ensure that Congress does not] solve those problems at the expense of the employer-provided system,” he said.
Nevada is a PIA Western Alliance state. Sen. Dead Heller is that state’s Republican in the Senate and he thinks in the end the Senate will move more in the direction of preserving much of what is good about ObamaCare.
Dan Holler of the group Heritage Action for America said that kind of talk is going to make it difficult for the party’s very conservative Senators to vote in favor. “There has to be a give and take, and right now it seems like conservatives are being told just to take it all and not get anything,” he said.
And while the Republicans in the Senate can’t quite figure out what they want to do, President Trump took to criticizing Democrats. “We're having no help; it's only obstruction from the Democrats. The Democrats are destroying health care in this country. If we gave you the greatest health plan in the world we would get no votes. The Democrats are really in our way,” the president said.
Source links: The Hill — link 1, link 2, link 3, link 4, The Washington Post, Employee Benefit Advisor