Governors who were shut out of the drive to repeal Obamacare implored Congress on Thursday to shore up the program by guaranteeing dollars the White House has threatened to withhold, while giving states a freer hand to shape their markets under the 2010 law.
Three Republicans and two Democrats told the Senate Health Committee to demand at least a year’s worth of federal cost-sharing money that reimburses plans for paying low-income customers’ costs, saying Mr. Trump’s attempt to use the money as leverage in the repeal fight is forcing insurers to boost premiums and head for the exits.
“While the perspectives of the five governors appearing before you this morning are certainly as diverse as the landscapes we represent, we’re uniform in insisting that cost-sharing reduction payments be continued,” said Montana Gov. Steve Bullock, a Democrat who wants a two-year guarantee.
Utah Gov. Gary Herbert, a Republican, said the payments aren’t the most “transparent and effective” way to assist customers, but he wants them funded through 2019, anyway, since insurers cannot price their products adequately without a commitment.
Thursday’s hearing offered governors the type of public forum they were denied during the debate over repeal, when Republican leaders rushed to pin down votes for bills that would fulfill their promise to kill off the 2010 Affordable Care Act.
For months, GOP holdouts in the House and Senate told leaders could have produced a better bill by vetting ideas in public instead of plotting repeal behind closed doors.
Sen. John McCain, Arizona Republican, cited the lack of hearings and input from state leaders in casting the pivotal vote against a limited repeal measure in July, enraging Mr. Trump.
The governors said they appreciated having a seat at the table this time around.
“Thank you for your willingness to engage in a bipartisan way in order to find much-needed solutions,” said Massachusetts Gov. Charlie Baker, a Republican. “I am especially appreciative that you have convened a group of governors to testify, as we are on the front lines and are eager to work with Congress and the federal government on health care reform.”
Committee Chairman Lamar Alexander, Tennessee Republican, and Sen. Patty Murray, the panel’s senior Democrat, say Congress has no choice but to come together and devise quick fixes to markets besieged by raising rates and fleeing insurers.
As it stands, more than 60 counties in Virginia might not have any choices at all, after Optima said the exit of fellow insurers and uncertainty from Washington left them no choice.
Insurance companies must decide this month whether to participate next year in the individual market, where roughly 18 million Americans buy coverage on their own.
Governors say the cost-sharing payments are a key part of the companies’ calculus, since Republicans secured a court ruling that would allow Mr. Trump to withhold the payments if he so chooses.
In exchange for cost-sharing money, Mr. Alexander wants to win Republican support by speeding up waivers, known as a “1332s,” that would allow states forge their own path under Obamacare. He says state should be allowed, for instance, to pare back the slate of medical services states are required to cover.
“We support essential health benefits. However, even in our state, it was a challenge to adapt to the overly strict federal framework of the ACA,” said Mr. Baker of Massachusetts, whose state paved the way for Obamacare with its own health reforms.
Mr. Alexander said maybe governors and state insurance commissioners should be able to apply for a waiver without waiting for state lawmakers to approve the changes in law, since some legislatures have only one session every two years.
He also thinks “copycat” waivers should be expedited.
“If Washington state gets something approved, why can’t Tennessee come along and say, ’We want to do what Washington state did with one change?’” the chairman said. “That ought to speed things up.”
Democrats say they’re leery of letting states cut away at Obamacare’s strictures in exchange for just one year of cost-sharing payments.
However, all sides have found common ground on “reinsurance,” in which the government sets aside a pool of money to subsidize the highest-cost consumers, so insurers don’t take a heavy hit and charge higher rates across the board.
But Mr. Alexander said states should pay for it themselves instead of tapping more funds from federal taxpayers. He cited Alaska and Minnesota, which rededicated federal money it was getting anyway, and Maine, which tacked a $4 surcharge onto each healthy policy sold in the state.
The chairman also highlighted Senate interest in letting people of all ages to buy “copper plans,” a low-cost tier of offerings that might attract young and healthy people who’ve largely dismissed Obamacare so far.
The effort still faces long political odds. It would have to pass both the Senate and House with great enough support to compel Mr. Trump’s signature. So far, the president has shown little interest in shoring up his predecessor’s signature achievement.
“If we act,” Mr. Alexander said, “then we’ll count on the House of Representatives and the president to take advantage of that, and my hope is that they would.”
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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