American Health Care bill

Senate HELP Committee Seeks to Craft Bipartisan Health Care Proposals

The first few weeks of September have brought more chapters in the story of Congress’ consideration of how to fix problems with aspects of the American health care system including what, if anything, should come after the Affordable Care Act (ACA).

Some U.S. Senate Republicans are working to determine whether the Graham-Cassidy bill to repeal “Obamacare” can generate the 50 votes needed for passage. In a change from the summer’s bitter partisanship, the Senate Committee on Health, Education, Labor and Pensions (HELP) has hosted four bipartisan hearings this month regarding the ACA.

The HELP committee’s efforts are motivated in part by a desire to shore up the individual insurance marketplaces or “exchanges.” Insurers must decide by Sept. 27 whether they will offer plans on the exchanges in 2018. While all counties in the U.S. now have at least one insurer in the exchange, concerns remain about affordability of exchange plans.

Cost Sharing Reduction Payments and Flexibility for States Remain a Focus; Experts from Wisconsin Offered Insights

 Two issues have occupied great deal of attention for the Senate in the past few weeks:  funding the cost sharing reduction payments currently made to insurers who offer coverage on the exchanges, and providing states with additional flexibility to cover their highest cost citizens not on Medicaid or covered by employer-sponsored health insurance.

HELP Committee Chair Lamar Alexander (R-Tenn.) and ranking Democratic member Patty Murray (D-Wash.) have offered proposals to continue funding of cost sharing reduction payments (CSRs) and to provide greater flexibility for states under what are called 1332 waivers.

Among those who testified over the last two weeks were a bipartisan group of governors, insurance regulators and industry leaders. Speakers included two people from Wisconsin: Tammy Tomczyk, Senior Principal and Consulting Actuary with Oliver Wyman Actuarial Consulting in Milwaukee and Dr. Susan L. Turney, CEO of Marshfield Clinic Health Systems in Marshfield, Wis.

Tomczyk’s firm helped the state of Alaska receive its 1332 waiver. Under the waiver, Alaska will provide reinsurance for insurers who cover individuals with certain high-cost conditions. Tomczyk outlined policies that would improve the waiver program, including allowing states more flexibility in defining the essential health benefits that must be covered by all plans.

Turney addressed concerns raised by some conservative Republicans that CSR payments are “bailouts” for the health insurance industry. Turney addressed this view directly, stating, “Finally, we take exception to the implication that these CSR payments are a bailout to insurance companies. The CSR payments are simply a pass-through payment to providers, with no financial benefit to health insurers.”

Bipartisanship on Health Care in Congress?  Reasons for Skepticism and Hope

The HELP Committee’s bipartisan efforts have been put on hold, for now, until Republicans determine whether or not they have the votes to pass an ACA repeal.  So far, they don’t have 50 “yes” votes, but they also don’t have 50 “no” votes.  They are vigorously working on the uncommitted. Sept. 30 is coming quickly.

As it stands, Chairman Alexander remains committed to his view that the HELP committee should strive for a bipartisan solution. Even if the Senate can come to consensus on the way forward, it is not at all clear that a Senate bill could pass the more polarized House. And, why would President Trump sign a bill that might strengthen certain provisions of the ACA when he has publicly stated that he expects the ACA to “implode?”

Disruption in one part of the health care industry quickly ripples to touch all those who participate in it, including self-funded employers. Congress now has less than two weeks to pass a bill that will provide insurance companies the certainty they need to participate in next year’s individual health insurance marketplace. Even this small step has proven to be difficult in the current polarized environment.

This suggests that any greater energy for health care reform will need to continue to come from other places, including from employers and employer purchasing coalitions.

Karen Timberlake

Karen Timberlake

Health Policy Consultant at Michael Best Strategies
Karen E. Timberlake is senior advisor at Michael Best Strategies LLC, where she focuses on shared value consulting, sustainable community development, and health system innovation. Before joining Michael Best Strategies, Karen was the Director of the University of Wisconsin Population Health Institute and an Associate Professor at the UW School of Medicine and Public Health. She previously served as Secretary of the Wisconsin Department of Health Services and as Director of the Office of State Employment Relations.
Karen Timberlake

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