Despite President Trump’s mixed messages, key senators unveiled their bipartisan plan Thursday to stabilize health insurance markets, drawing widespread support.
Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health committee, and the top Democrat on the panel, and Sen. Patty Murray of Washington jointly announced 22 bipartisan co-sponsors to their effort, more than typical for a bill.
Alexander noted that Trump, too, continued to encourage him to push forward. The president called the senator twice Wednesday, even after speaking critically of the plan.
“I want to thank him for his encouragement,” Alexander said.
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At the core of Medicaid’s troubles is its provider reimbursement system, which is based on price controls. In general, it pays rates substantially less than those of private insurance and can even be less than the cost to deliver that care. According to a Kaiser Family Foundation analysis, in 2016, Medicaid reimbursed physicians across the country 72 percent of Medicare rates for all services and 66 percent of Medicare rates for primary care. In general, Medicare rates are already less than those of private insurance. With noncompetitive reimbursement and the administrative hassle of the program, many providers are reluctant to accept Medicaid patients.
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President Trump has defended his decision to end cost-sharing reduction (CSR) subsidies — an element of the Affordable Care Act that helped lower the cost of deductibles and co-pays for people making less than 250 percent of the federal poverty level — by pointing to the gain in stock prices for health-insurance companies.
Insurance companies do not make money through the cost-sharing provision, estimated to be worth about $7 billion in fiscal 2017. They’re being paid back for money they’ve already spent. If they do not get repaid for doing what is required under law, companies say they will raise premiums to make up the difference.
That in turn will raise the cost to taxpayers, because whatever savings result from eliminating the CSRs will be exceeded by additional costs for higher tax credits to defray the new premiums.
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Sen. Alexander deserves credit for trying to steer the GOP out of the health care wilderness. But the deal Sen. Alexander negotiated with Sen. Murray has a major flaw: It would fund the cost-sharing reduction payments authorized by the ACA for two years, through 2019. The GOP should not agree to fund cost-sharing reduction payments beyond 2018 absent a much more comprehensive deal on health care. An agreement to fund the cost-sharing subsidies through 2019 would all but ensure that Democrats in Congress will stonewall further negotiations on health care until after the mid-term elections in November 2018.
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How does Washington define “bipartisan”? We are about to find out if it means that Republicans surrender to everything Democrats want, or if it means a genuine trade of policy priorities in which both sides get something and the country benefits.
That’s the question to ask about this week’s deal between Republican Lamar Alexander and Democrat Patty Murray to appropriate two years of funding for Obama Care’s “cost-sharing” reductions that flow to insurers. The Trump Administration last week cut off these subsidies, which the Obama Administration paid without an appropriation from Congress. A federal judge ruled last year that those payments are illegal. Democrats would also get about $100 million for advertising ObamaCare.
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Any agreement to restore funding for cost-sharing payments should be tied to provisions allowing families to opt out of ObamaCare and buy coverage that meets their individual needs. The compromise should also grant insurers the right to sell such plans independent of ObamaCare’s rules and its rigged risk pool.
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GOP lawmakers acknowledge they’ll eventually have to contend with shaky insurance markets and what to do about the elimination of remaining cost-sharing subsidy payments due this year. If a stand-alone bipartisan bill cannot be passed, money to fund the key insurance subsidy program could be resurrected as part of a year-end spending agreement.
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The White House says that substantial changes must be made to a bipartisan health-care deal for President Trump to support it.
The changes would push the bill to the right, raising serious doubt about whether Democrats would agree to the deal.
A White House official said Wednesday night that the deal should include “relief” from ObamaCare’s individual mandate, which requires that people have health insurance. The mandate is a central component of ObamaCare of which Democrats are protective and Republicans critical.
A majority of voters back a key component of President Trump’s executive order. Fifty-two percent of voters said they support Trump’s plan to make it easier for small businesses to band together in associations to sponsor low-cost, less comprehensive health care coverage across state lines, while 30 percent said they oppose the policy, according to a new Morning Consult/Politico poll. 39% believe the executive order will lead to lower insurance premiums and 36% said health insurance costs would be likely to rise.
Sens. Lamar Alexander and Patty Murray say they have reached an agreement on a bipartisan Obamacare deal to fund a key insurance subsidy program and provide states flexibility to skirt some requirements of the health care law.
There is no assurance that the agreement will get to the Senate floor, however. Republicans on Tuesday were lukewarm about the prospect of resuming debate over whether to try to prop up Obamacare after multiple failed GOP attempts to repeal the law.
The deal would include funding through 2019 for Obamacare’s cost-sharing program, which President Donald Trump cut last week. It would allow states to use existing Obamacare waivers to approve insurance plans with “comparable affordability” to Obamacare plans, Alexander said. But it would notably not allow states to duck the law’s minimum requirements for what a health insurance plan must cover.
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