The Trump administration says it is willing to continue paying subsidies to health insurance companies under the Affordable Care Act even though House Republicans say the payments are illegal because Congress never authorized them. The statement sends a small but potentially significant signal to insurers, encouraging them to stay in the market. The future of the payments has been in doubt because of a lawsuit filed in 2014 by House Republicans, who said the Obama administration was paying the subsidies illegally.
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Here is something you can take to the bank. If Republicans can’t produce an alternative to Obamacare that solves the real problems of ordinary people, they will never be able to pass a health reform bill. But if they do solve problems, they will have no trouble getting support — even from Democrats.
That means getting the focus right. Over the past three years there have been a series of Republican proposals that have been excessively focused on Obamacare rather than on a conservative approach to health reform. These proposals have been hell bent on repealing Obamacare taxes and Obamacare mandates instead of solving the problems that Obamacare has created or exacerbated.
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Republicans left Washington on Friday without a health-care deal, despite renewed negotiations after last month’s fiasco and a burst of White House diplomacy. Perhaps the two-week recess will be a cooling-off period and we hope the House’s factions can agree on a deal. If they can’t, then at least we’ll learn who’s responsible for defeat.
President Trump and Republicans campaigned on repeal and replace, and the President at least wants to keep his word. The ObamaCare exchanges are also fragile and precarious, and consumers harmed by rising premiums and declining choices are likely to blame the party in power.
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House Republicans continue to work toward a health care deal but are currently in a holding pattern as they await further details from the Trump administration on proposed changes to the bill. “We don’t have bill text or an agreement yet,” Speaker Paul Ryan told reporters after meeting with the GOP conference Tuesday morning. He declined to discuss details of proposed changes, saying “productive conversations” were happening at the “conceptual level” regarding how to lower insurance premiums while maintaining “solid protections for people.” House Freedom Caucus members said the same thing Monday night after leaving a meeting where Vice President Mike Pence and Trump administration officials, including White House Chief of Staff Reince Priebus, discussed the proposed changes with them.
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One of the ill-fated bill’s greatest weaknesses was that it did not have a unifying purpose or goal. Was it about access or coverage? Cost or quality? Individual choice or collective responsibility? The answer was, effectively, a bit of each, due to congressional negotiations and the president’s pre-inauguration pronouncements. Canadian F.H. Buckley caused a maelstrom in conservative circles last week when he called on President Trump to advance a single-payer model for U.S. health care. The first step in any renewed effort to reform American health care is to define the objectives.
A second major health-insurer has decided to quit selling individual policies in Iowa, raising fears that tens of thousands of Iowans will have no options for coverage next year.
Aetna informed Iowa regulators Thursday that it had decided to stop selling such policies, which cover people who lack access to employer-provided coverage or government plans. The move would affect 36,205 customers, the company told regulators.
Aetna’s move takes effect in January. It came three days after Iowa’s dominant health-insurer, Wellmark Blue Cross & Blue Shield, announced that it would no longer sell individual health-insurance policies in Iowa.
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More insurance companies around the country are refusing to pay brokers commissions on higher-tier exchange plans or special enrollment sales as the companies face financial losses on the federal marketplace. “It’s the Wild West out here, and companies are doing what they can to survive,” says Ronnell Nolan, CEO of Health Agents for America, which represents independent insurance brokers. “They’re not paying commissions on platinum plans, and they are not paying them for special enrollment plans which cover some of the sickest patients.” An exodus of brokers from the federal marketplace could undermine enrollment efforts since brokers historically sign up at least 50% of exchange enrollees.
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The deal House Republicans reached on Thursday addresses a key problem with their alternative to the Affordable Care Act: steep premiums. The provision, which House Republicans decided to add to their Obamacare replacement bill before they face constituents during the Easter recess, would dole out $15 billion to states over about a decade to help insurers cover the sickest people in the health care system and reduce premiums for individual health plans.
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It looks like House Republicans have been trying over the past few days to coalesce around a revised version of the AHCA. One key revision has involved a more assertive temporary federal reinsurance scheme to quickly lower premiums and stabilize the transition period to a new system. But maybe the most significant, and least familiar, new proposal has involved allowing states to obtain waivers from some Title I regulations in Obamacare. The devil will be in the details, and they will matter enormously here, but the general concept of returning regulatory power to the states through waivers that are connected to the bill’s spending measures is an interesting way to deal with the constraints Republicans confront and could have real promise.
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Health and Human Services Secretary Tom Price holds broad authority over administration of the Affordable Care Act, including the power to give additional flexibility to states and insurers under the law. Section 1332 of the ACA allows HHS to offer “state innovation waivers” for that allow states to waive some (but not all) of Obamacare’s insurance regulations in return for a block grant of ACA funding. States that want to keep the ACA status quo could do so, while Republican-led states could go in a different direction.
An approach that started with 1332 waivers and layered on additional legislative reforms would allow both the more conservative and moderate members of the GOP to declare victors, because the states themselves would be put back in charge of their own health insurance markets.
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