Tag Archives: Reinsurance Funding

House GOP warming to ObamaCare fix

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House GOP warming to ObamaCare fix

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Key House Republicans are warming to a proposal aimed at bringing down ObamaCare premiums, raising the chances of legislative action this year to stabilize the health-care law.

House GOP aides and lobbyists say that top House Republicans are interested in funding what is known as reinsurance. The money could be included in a coming bipartisan government funding deal or in another legislative vehicle.

Any action from Republicans to stabilize ObamaCare would be a major departure from the party’s long crusade against the law, but after having failed to repeal the Affordable Care Act last year, the discussion is shifting.

Rep. Ryan Costello (R-Pa.) is one of the leaders of the push in the House and is sponsoring a bill to provide ObamaCare stability funding in 2019 and 2020. He notes the relatively short-term nature of his measure.

“That reflects the political reality that we are not going to be doing some large, sweeping health-care bill in the next year,” said Costello, who faces a competitive reelection race this year.

“I am optimistic that it would be under serious consideration for inclusion in the omnibus,” he added.

Speaker Paul Ryan (R-Wis.) noted the possibility of action on an ObamaCare stability measure, particularly funding for reinsurance, at an event in Wisconsin in January, saying he thought there could be a “bipartisan opportunity” on the issue.

Action on the reinsurance payments is far from certain; conservative opposition to what some view as a bailout of ObamaCare insurers could stop the proposal in its tracks. But there is growing momentum for the idea, and Republicans said the proposal would likely be discussed more at the GOP retreat this week in West Virginia.

The push on reinsurance matches up with one of the ObamaCare bills that Sen. Susan Collins (R-Maine) has been pushing in the Senate.

Senate Majority Leader Mitch McConnell (R-Ky.) gave Collins a commitment to support a reinsurance bill as well as another stability measure from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) in exchange for Collins’s support for tax reform in December.

Opposition in the House has always been the major impediment to those measures moving forward. But it now appears some of that resistance is softening, at least on the reinsurance measure, now that Republicans have repealed ObamaCare’s individual mandate through the tax bill.

Importantly, House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), whose panel has jurisdiction, is supporting the ObamaCare stabilization efforts and backs Costello’s bill.

“Chairman Walden is supportive of Rep. Costello’s efforts to help states repair their insurance markets that have been damaged by Obamacare,” an Energy and Commerce spokesperson wrote in an email. “Rep. Costello’s bill is a fair approach to granting states greater flexibility to help patients and lower costs.”

Rep. Cathy McMorris Rodgers (R-Wash.), the fourth-ranking Republican in House leadership, is also a co-sponsor of Costello’s stabilization bill.

While House conservatives have opposed propping up ObamaCare, Rep. Mark Meadows (R-N.C.) did not dismiss the payments out of hand on Tuesday.

“If it lowers premiums, I’m willing to listen to any ideas,” said Meadows, who is chairman of the House Freedom Caucus.

He warned that he did not want a proposal to be an “insurance bailout,” but noted that he has been talking to colleagues in the House and Senate about the issue.

Another obstacle for an ObamaCare fix is a dispute over abortion. Republicans are adamant that a stabilization measure must include restrictions on the new funding being used to cover abortion services, a notion that is problematic for Democrats.

Reinsurance funding is used to help insurers cover the costs of especially sick patients, which helps relieve pressure on premiums for the broader group of enrollees.

The other main stabilization measure, from Alexander and Murray, would fund ObamaCare payments that reimburse insurers for giving discounts to low-income enrollees, known as cost-sharing reductions (CSRs).

Republican sources say there is less momentum in the House for funding CSRs than there is for the reinsurance measure. But even some Democrats are now questioning whether funding CSRs still makes sense, given that through a quirk in the law, President Trump’s cancellation of the payments last year actually led to increased subsidies and lower premiums for many enrollees.

Rep. Phil Roe (R-Tenn.), for example, a leading House Republican on health-care issues as co-chairman of the GOP Doctors Caucus, said Tuesday that he feels negatively about the idea of funding CSRs but likes the idea of reinsurance.

Roe pushed back on the idea that the funding would be propping up ObamaCare, saying that the repeal of the individual mandate had changed the discussion because people no longer were forced to buy coverage.

Roe said he runs into people in his district paying more than $1,000 per month in premium costs.

“We’re going to have to do something,” he said.

GOP faces pressure on community health funding

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Congress has knocked one big item off of its health care to-do list, but there are some other controversial issues lawmakers will need to tackle.

The Children’s Health Insurance Program was funded for six years in the stopgap government funding bill that keeps the government open until Feb. 8, but another major health-care program needs to be extended as well: funding for community health centers.

That is one of the items that could get wrapped up in a future government funding bill, either ahead of the Feb. 8 deadline or in a longer-term spending bill down the road.

Democrats have started hammering home the need for community health center funding.

“I’m very glad we were able to pass the extension of children’s health care, but now we need to work together to tackle those other critical health care issues that Republicans have now allowed to expire, because there’s no excuse for leaving families wondering whether their local health care center will shut its doors,” Sen. Patty Murray (D-Wash.) said on Tuesday.

House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) has pushed back on the idea Republicans are to blame, noting that community health center funding was in a bill House Republicans passed in November but that the Senate did not take up.

“Republicans support community health centers and are continuing to work to fund the program for the long term,” Walden wrote in Morning Consult. “I know the ongoing debates have not been easy on the workers at these facilities and the families that rely on them for vital medical care, and I share their frustrations.”

On Monday, the Senate will hold a vote on a bill to ban abortions after 20 weeks of pregnancy, a major priority for anti-abortion groups. The bill is not expected to be able to get the 60 votes needed to advance, but it could pose a tough vote both for some red state Democrats and for Republicans who support abortion rights.

Sens. Susan Collins (R-Maine), Lamar Alexander (R-Tenn.), and top Democrats are also pushing to pass a pair of bipartisan ObamaCare fixes aimed at stabilizing markets and bringing down premiums.

Those measures are opposed by House conservatives, but Speaker Paul Ryan (R-Wis.) has shown some openness to at least one of the bills, which provides funding known as reinsurance to bring down premiums.

The GOP is getting closer to passing its tax bill. Here’s what it could mean for health insurers

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The House and Senate have agreed upon a unified tax overhaul bill, putting Republicans on the fast track to pass legislation that has significant implications for the health insurance industry.

For one, the compromise tax bill will repeal the Affordable Care Act’s individual mandate penalty, Senate Majority Leader Mitch McConnell said in a statement on Wednesday. To McConnell, axing the mandate will offer “relief to low- and middle-income Americans who have struggled under an unpopular and unworkable law.”

Health insurers and the healthcare industry at large have opposed removing the key ACA provision without a viable alternative to encourage healthy consumers to buy coverage, arguing that doing so will destabilize the individual markets. Indeed, the Congressional Budget Office has estimated that repealing the mandate would increase the number of uninsured people by 13 million over the next 10 years and hike individual market premiums by 10% during most years of that decade.

Yet while the individual mandate repeal is problematic for insurers that do business on the ACA exchanges, nearly all insurance companies stand to gain from the GOP tax bill overall, according to Leerink Partners analyst Ana Gupte, Ph.D. She estimates that insurers can capture about 10% to 15% of the potential 25% upside from the legislation, subject to regulatory constraints such as medical loss ratio rules and competitive pricing constraints.

Likely the biggest gain for insurers is the fact that, per the New York Times, the compromise bill sets the corporate tax rate at 21%—significantly lower than the current rate of 35%.

Though the House and Senate have ironed out the differences in their bills, the final version still must be approved by both chambers. GOP leaders have but two votes to spare in the Senate, and will likely have to include two bipartisan measures to shore up the ACA in Congress’ year-end spending bill to win the support of Sen. Susan Collins, R-Maine.

Collins said on Wednesday that Vice President Mike Pence assured her that those measures would make it into the spending bill, according to The Hill. Yet some House conservatives have expressed opposition to the bills, which would provide funding for cost-sharing reduction payments and state-based reinsurance programs, among other provisions.

Meanwhile, the results of the headline-grabbing Senate race in Alabama have put a major crimp in Republicans’ plans to retry repealing the ACA. Once Democrat Doug Jones officially takes his seat, the GOP will have an even slimmer majority in the Senate, where the defection of a handful of moderate Republicans was already enough to kill several repeal bills earlier this year.

 

Actuaries warn of premium increases from repealing ObamaCare mandate

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Actuaries warn of premium increases from repealing ObamaCare mandate

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A group of insurance experts is warning Congress against repealing ObamaCare’s individual mandate, saying the move would raise premiums and could cause insurers to drop out of the market.

The American Academy of Actuaries wrote to congressional leaders on Tuesday saying that “eliminating the individual mandate would lead to premium increases.”

The Republican tax-reform bill which is nearing completion in Congress would repeal the ObamaCare mandate that people have health insurance or pay a fine.

Republicans argue the measure included in the Senate-passed bill is tax relief by removing a penalty for low-income people who choose not to buy insurance.

The actuaries warn that repealing the mandate would harm the health insurance market by removing an incentive for healthy people to enroll and balance out the costs of the sick.

The insurance experts also say that a measure pushed by Sen. Susan Collins (R-Maine), intended to help offset the premium increases from repealing the mandate, would not be enough to make up the difference.

That bill, sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray(D-Wash.), would fund key ObamaCare payments known as cost-sharing reductions. The actuaries say the payments “would not offset premium increases due to an elimination of the mandate.”

The letter says additional measures — such as funding to bring down premiums known as “reinsurance,” which Collins has also proposed — could help, though. Some experts say more funding than is currently proposed would be needed.

The instability from repealing the mandate also could lead some insurers to drop out of markets altogether, the actuaries warn, potentially leaving some people with no insurance options.

“Insurers would likely reconsider their future participation in the market,” the actuaries write. “This could lead to severe market disruption and loss of coverage among individual market enrollees.”

 

 

ObamaCare fight could threaten shutdown deal

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ObamaCare fight could threaten shutdown deal

ObamaCare fight could threaten shutdown deal

A fight over ObamaCare is spilling into Congress’s December agenda, threatening lawmakers’ ability to keep the government open.

President Trump signed stopgap legislation Friday aimed at averting a shutdown and keeping the government funded through Dec. 22. The bill allows lawmakers to focus on the next — and seemingly more difficult — negotiating period.

Lawmakers on both sides of the aisle have a host of priorities they want to include in the bill, but the question of funding ObamaCare’s cost-sharing reduction (CSR) payments appears to have divided Republicans.

Senate Republicans want to include the cost-sharing payments in the spending package, but House conservatives have little interest in funding subsidies they see as bailing out a law they despise.

Senate Republican leaders view the payments as a necessary bargaining chip.

In order to pass their tax-reform bill and get a much-needed legislative victory, Senate Majority Leader Mitch McConnell (R-Ky.) made a deal with Sen. Susan Collins (R-Maine), a key swing vote.

In exchange for Collins’s vote for the tax bill, McConnell gave an “ironclad commitment” to pass a pair of bipartisan bills.

One bill, sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), would temporarily fund the cost-sharing payments. Another would provide “reinsurance” — money to pay for the costs of sick enrollees and bring down premiums.

Together, the bills would shore up ObamaCare’s insurance markets, which experts predict could be gutted by a provision of the tax bill that repeals the mandate to buy health insurance.

But the commitment to Collins came from McConnell, who can’t force the House to take up legislation. Speaker Paul Ryan (R-Wis.) hasn’t given any indication that he would support passing the ObamaCare bills, though he also hasn’t ruled it out.

“I wasn’t part of those conversations,” Ryan told reporters Thursday when was asked about McConnell’s promise to Collins. “I’m not deeply familiar with those conversations.”

Earlier in the week, Ryan reiterated his commitment to repealing ObamaCare, but didn’t tip his hand on the spending bill.

“We think health care is deteriorating. We think premiums are going up through the roof, insurers are pulling out and that’s not a status quo we can live with,” Ryan said.

House conservatives have also said they have little energy for passing a government funding bill that contains any ObamaCare provisions.

“None of us voted in favor of ObamaCare, so supporting it, sustaining it’s not exactly a high objective,” said Rep. Tom Cole (R-Okla.), a leadership ally.

Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee, said that he had been assured by House leaders that ObamaCare payments would not be attached to the next funding bill.

“The three things that we’ve been told are not going to happen as part of our agreement: no CSRs, no DACA, no debt limit,” Walker said, referring to the Deferred Action for Childhood Arrivals (DACA) program, which offered protections for immigrants brought into the country illegally as children. Trump ended the program with a six-month delay in September.

When asked about any assurances made to Walker, Ryan’s office declined to comment on member discussions.

Separately, Walker said any effort to add ObamaCare provisions to the spending bill would cost Republicans more votes from the GOP than they would gain with Democratic lawmakers.

If the Senate includes ObamaCare payments in the funding package, it could force a showdown with House Republicans, who would be under pressure to pass the Senate’s bill or risk a shutdown.

For now, Democrats are trying to maximize their leverage and are content to let Republicans fight among themselves.

Republicans need at least eight Democrats to break a filibuster in the Senate for any spending bill, and often rely on Democrats to make up for GOP defections in the House.

Alexander, who has long pushed for his bill to be included in a year-end spending bill, dismissed the idea that Republican senators need to pressure their House colleagues.

“The president’s for it, Sen. McConnell’s for it, most Republicans in the House have voted for both two years of cost sharing” and reinsurance in the past, Alexander said. “I feel pretty good about it.”

 

 

Centrist Democrats Turn to Pragmatism, Seek Bipartisan ACA Fixes

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https://morningconsult.com/2017/09/15/centrist-dems-seek-bipartisan-aca-fixes-not-single-payer-plan/

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While some progressives campaigned this week for “Medicare for all,” a group of moderate House Democrats aligned themselves with a more modest push to stabilize the Affordable Care Act, arguing that it could spur broader health care reforms in the future.

Thirty-eight of the 61 members of the New Democrat Coalition sent a letterFriday urging the leaders of the Senate Health, Education, Labor and Pensions Committee to agree on a bipartisan bill to keep premiums from rising further for Obamacare enrollees next year.

The letter outlines five short-term proposals agreed to by the group — several of which are likely to be included in the Senate bill, such as the extension of key insurer payments known as cost-sharing reductions.

New Democrat Coalition Chair Rep. Jim Himes (D-Conn.) said that while some Democrats and Republicans continue to push polarizing health care plans after the July collapse of Senate Republicans’ Obamacare repeal push, some lawmakers of both parties are ready to try bipartisanship.

“There’s a pretty substantial group of Democrats and Republicans who are ready to work together and get some things done on this most politically charged of topics,” Himes said in an interview Thursday.

Only three of the 38 Democrats who signed the letter are co-sponsors of a single-payer health care bill introduced by Rep. John Conyers (D-Mich.) that has been endorsed by approximately 60 percent of the House Democratic caucus; Sen. Bernie Sanders (I-Vt.) introduced similar legislation in the Senate on Wednesday.

But the progressive single-payer legislation has almost no chance of passing the Republican-led Congress, and members of the New Democrat Coalition are taking a more pragmatic approach: While “Medicare for all” proponents support placing nearly all Americans on a government plan, the New Democrat Coalition is backing reforms to improve private health insurance coverage and reduce health care costs.

“We believe these ideas provide a framework to reduce health care costs for families and seniors, increase choices for consumers, and encourage participation by the young and healthy,” the Democrats wrote in the letter.

Some members of the New Democrat Coalition are also in the House Problem Solvers Caucus, which consists of centrist GOP and Democratic lawmakers and sent its own letter Wednesday urging the Senate HELP and Finance committees to move toward a bill as a crucial Sept. 27 deadline for insurers approaches.

HELP Committee Chairman Lamar Alexander hopes to reach an agreement on the legislation by early next week, the Tennessee Republican said at a hearing on Thursday.