The Senate Health Committee launched a politically ambitious effort Wednesday to shore up Obamacare’s ailing markets, saying nearly 20 million Americans are counting on them to find common ground after President Trump’s push to repeal and replace the law collapsed.
Chairman Lamar Alexander, Tennessee Republican, said he wants to find a compromise by the end of next week that funds critical payments to insurers and devolves power to the states, hoping to bring some certainty as companies decide whether to participate in the individual market in 2018.
“We ought to be able to take this small, limited bipartisan step on health insurance. If we don’t, millions of Americans will be hurt,” Mr. Alexander said, laying blame for potential failure on both parties.
Obamacare customers in roughly half of America’s 3,000 counties will have just one insurer on their exchange next year, and many face another round of double-digit premiums increases.
While taxpayers will shell out more cash to blunt rising costs for some customers, up to 9 million people on the individual market do not qualify for subsidies and will pay full freight.
Oklahoma Insurance Commissioner John D. Doak, one of five state insurance commissioners to testify, said his state has been left “holding the bag” after the 2010 law fell short of its promises and Republican attempts to replace it fizzled.
He pleaded for sweeping changes and endorsed a repeal bill that would block-grant health care dollars to the states.
Commissioners from blue states urged lawmakers to bolster the existing program, however, saying Mr. Trump’s wavering commitment to the program poses the most urgent threat.
“Our individual market is not collapsing,” said Teresa Miller, acting secretary for the Pennsylvania Department of Health and Human Services.
Wednesday’s session is the first of four hearings as the committee tries to write a bill to stabilize the Affordable Care Act’s private marketplace, which is reeling from flaws in the law itself and Mr. Trump’s seesawing on enforcement and critical funding.
Leaders presented the stabilization effort as a kind of paradox. While it’s a minimal plan that works on the edges of Obamacare, getting any bipartisan deal done on the health law has been a major challenge.
Committee members asked substantive and earnest questions during the three-hour session, a stark turnaround from Obamacare hearings that in prior years devolved into partisan showmanship and sniping.
As envisioned, the committee’s work product would give Democrats a win by funding “cost-sharing” payments to insurers and reinsurance programs that blunt the cost of particularly sick customers, so others don’t have to pay more.
In exchange, Republicans want to let states waive some of Obamacare’s guardrails, such as the slate of medical services that insurers are mandated to cover.
“That is called a ’compromise,’” Mr. Alexander said.
He said people with pre-existing medical conditions will be protected, yet Democrats might still balk at any attempt to water down Obamacare’s regulations.
“I think we’re all aware that threading this needle will not be easy,” Sen. Patty Murray, the panel’s ranking Democrat, said. “But I do believe an agreement that protects patients and families from higher costs and uncertainties, and maintains the current guardrails in our current health care system, is possible.”
All sides seemed to agree that reinsurance — in which money is set aside to subsidize a market’s most expensive consumers — has been an effective tool, so Congress should make it easier for states to win federal approval of such programs.
But Mr. Alexander also said reinsurance should be funded through state taxes, rather than asking federal government to take on more debt.
Democrats say their main worry is Mr. Trump, who still wants to repeal Obamacare and is willing to use its core mechanisms as leverage in the debate. The White House slashed enrollment adverting and outreach funding by more than $100 million ahead of the sign-up season beginning Nov. 1, and Mr. Trump has refused to guarantee the cost-sharing payments.
The White House is still hoping to revive the repeal effort before Sept. 30.
Republican Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana and Dean Heller of Nevada are pushing a plan that would pass health care funds to states, so they can make their own plans.
“I think it’s a good proposal and I think we ought to support it,” Sen. John McCain, Arizona Republican and key swing vote, said Wednesday, adding governors must rally around it first.
The bill hasn’t been filed or scored by budget analysts to see if it satisfies arcane budget rules, however, and some lawmakers fear the block-grant model will lead to significant cuts to Medicaid insurance for the poor.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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