Senate Republicans increasingly are expressing a willingness to consider a bipartisan approach to strengthening the individual insurance market under the Patient Protection and Affordable Care Act, even as President Donald Trump is deciding whether to end payments for it.
"We have got a destabilized market where insurance rates are going to go up 20, 30, 40 percent next year," Sen. Thom Tillis, R-N.C., said Sunday on ABC's This Week. "Anything that we can do to prevent that and the damage that that will have on people who need health care, I think is something I have to look at."
The Senate health committee plans to begin bipartisan hearings early next month with the goal of stabilizing the individual insurance market, the committee's Republican chairman, Lamar Alexander of Tennessee, and top Democrat, Patty Murray of Washington, announced last week.
At issue now is the payments, called cost-sharing reductions, which help insurers offset health care costs for low-income Americans. Trump has repeatedly suggested ending the payments as a bargaining tactic to bring Democrats to the negotiating table as Republican efforts to repeal and replace the Affordable Care Act have stalled.
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The subsidies are called for in the 2010 health care law, but they are under a legal cloud because of a lawsuit brought by House Republicans, who questioned whether the law included a specific instruction for the government to pay the money. The case is on hold before a federal appeals court; the administration has continued making monthly payments in the meantime.
"The cost-sharing reductions over time need to be eliminated," Tillis said. "But we can't just all of the sudden pull the rug out from underneath an industry that has had this in place for about seven years."
Senate Majority Leader Mitch McConnell said Saturday that he'd be open to the bipartisan attempt. He also said there was "still a chance" to revive the effort to replace the current health care law -- but that it was quickly becoming unlikely.
After the Senate's GOP health care proposal failed in a vote last month, the president sent out a series of tweets in which he seemed to threaten to stop the payments.
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"If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies...will end very soon!" said one of Trump's Twitter messages.
Experts say the money is not a bailout, but rather a government obligation. Without a subsidy guarantee from Trump, some insurers have been seeking double-digit premium increases, on top of raises that reflect underlying medical costs.
The next payment is due Aug. 21.
Appearing together on CBS' Face the Nation on Sunday, Gov. John Kasich, R-Ohio, and Gov. John Hickenlooper, D-Colo., said both parties should work to find a solution.
"Republicans are going to have to admit that there is a group of people out there who will need help," Kasich said.
"I think we'll be surprised at the number of senators that are willing to kind of step back and say, 'All right. Let's roll up our sleeves and work on a bipartisan basis and see how far we can go,"' Hickenlooper said.
Sen. Ron Johnson, R-Wis., said "we do need to stabilize those markets" but urged his colleagues to move on to other priorities.
"I really do think we probably ought to turn our attention to debt ceiling and funding the government and tax cuts until we can really get all the parties together," Johnson said Sunday on CNN's State of the Union.
Mixed messages
With the next sign-up period for insurance exchanges less than three months away, the government appears to be operating on contradictory tracks, according to insurers, state insurance commissioners, health policy experts and leaders of grass-roots groups that have worked to enroll consumers who now have coverage under the Affordable Care Act.
Trump continues to talk of people he terms "Obamacare victims," and the Health and Human Services Department is issuing weekly maps showing the few dozen counties that might lack a health plan on the exchanges for next year.
Yet many layers down in the government, the part of the Health and Human Services Department that directly oversees the law's insurance marketplaces and the federal healthcare.gov enrollment website has been carrying out much, if not all, of its regular work -- including convening its annual meeting in June with "navigators" who help steer consumers toward health plans and telling them at the time that the subsidies would continue, according to three participants.
Julie McPeak, Tennessee's insurance commissioner and the incoming president of the National Association of Insurance Commissioners, said she and colleagues have contacted officials at the Department of Health and Human Services, the Justice Department, the White House's intergovernmental affairs office, and the Office of Management and Budget, trying to learn which part of the government would make the decision about the cost-sharing payments and when such a decision could be expected.
"And we can't get a clear picture," McPeak said.
As a result, she noted, Tennessee cannot plan its own outreach efforts because it is impossible to provide consumers accurate information about insurance prices and choices for the coming year.
Officials at the June meeting provided no assurances about whether the administration would continue the government's usual enrollment activities or promotion. In January, Trump halted most advertising aimed at encouraging consumers to sign up before the deadline for 2017 coverage.
Health and Human Services Secretary Tom Price so far has sent mixed signals. His department recently canceled contracts with two companies that have helped thousands of Americans in 18 cities find health plans under the law. The suspension of the $22 million contracts ends enrollment fairs and insurance sign-ups in public libraries.
But the department did work with Alaska on a waiver that's been praised for helping to stabilize that state's insurance market. And the agency issued a regulation that made several changes insurers had requested to help things run more smoothly.
About 10 million people are signed up for private insurance in subsidized markets, and 11 million more have coverage through Medicaid expansions.
Mike Leavitt, a health care consultant and former Utah governor who served as Health and Human Services secretary under President George W. Bush, predicted that the two contracts cut last month -- with the northern Virginia-based companies Cognosante and CSRA -- will not be the last to go.
Still, Leavitt predicted the administration is unlikely to back away entirely from its role in the marketplaces in Trump's first year in office. "If you are the secretary of health, you don't want to buy yourself a huge mess at the end of the year ... by creating such an abrupt shift that the administration gets that blame," he said.
Information for this article was contributed by Ben Brody, Mark Niquette and Patricia Laya of Bloomberg News; by Amy Goldstein and Paige Winfield Cunningham of The Washington Post; and by Ricardo Alonso-Zaldivar of The Associated Press.
A Section on 08/07/2017