Mr. Trump and congressional Republicans are hoping the Labor Department will identify a way to allow associations and small employers to create self-insured plans—or something similar. That change could allow them to adjust benefits and offer more affordable coverage to more people. Since the passage of ObamaCare, however, states are no longer the driving force behind most insurance mandates and regulations. Washington is. A more straightforward solution would be for Congress to change the law.
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Conservatives are supposed to get two wins in the Alexander-Murray bill. The first is the creation of “copper” plans within the Obamacare exchanges. Moderate Democrats have championed this idea as a way for consumers to buy plans with lower premiums and higher deductibles than others available on the exchange. But because the plans would still be subject to Obamacare’s regulations, they would still be a far cry from the low-cost catastrophic plans that conservatives would like to see. The deal also gives states a little more flexibility — but constrains that flexibility in a way that makes it valueless. States would have to show that any policy changes they make would lead to a comparable number of people having the same kind of comprehensive coverage that Obamacare seeks to foster. But that’s not the kind of coverage conservatives want to make the focus of public policy.
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President Donald Trump will support a bipartisan bill on health care only if it includes a series of conservative measures that Republicans sought in their failed effort to repeal the Affordable Care Act, a White House spokesman said Thursday, as two senators officially unveiled the legislation without many of those demands. In order for Mr. Trump to support such legislation, it must provide relief from the ACA’s requirement that most people have health coverage or pay a penalty, the spokesman said Thursday. It should also roll back or end the requirement that certain employers provide health coverage, the White House official said.
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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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