By Blair Burnett, ACCC Policy Analyst
After a flurry of activity on healthcare over the past couple of months, a bipartisan proposal may be making gains in Congress. The highlights:
October 12, 2017 – The Trump Administration released an executive order that laid the groundwork for big changes to the Affordable Care Act (ACA) marketplaces including less comprehensive plans offered through associations of small employers as well as a push for increased use of short-term medical coverage. This could essentially create an alternative insurance market that would not have to comply with many of the consumer protections created under the ACA, and would likely attract healthier, less costly consumers, which would drive up premiums in the current exchanges. Later that evening, the Administration announced it would immediately end cost-sharing reduction (CSR) payments used to subsidize healthcare costs for low-income individuals on the exchanges. The legal battle around CSRs has been playing out in the courts since 2014, with some arguing that the payments are illegal because they were not appropriated by Congress. Analysis from the Congressional Budget Office (CBO) predicts large premium increases for exchange plans in 2018 and beyond, as insurers attempt to cover the loss of the CSR payments and some consider leaving the marketplaces all together.
October 17, 2017 – The following week, Chairman and Ranking Member of the Senate Health, Education, Labor, and Pensions Committee (HELP), Senators Lamar Alexander (R-TN) and Patty Murray (D-WA), announced a bipartisan bill designed to provide temporary stability in the marketplaces.
Key tenets of the Alexander-Murray proposal include:
- Continued Funding for CSR Payments: CSRs would continue to be funded through 2019. For states where insurance regulators are pressing individual insurers to decline this payment, no funding would be issued.
- Restoration of ACA Enrollment Funding: Any state participating in an exchange would see restoration of over $100 million in outreach and enrollment funding through 2019. This proposal also seeks transparency with open enrollment advertising and outreach with a mandated reporting timeline.
- Preexisting Conditions & Essential Health Benefits Coverage Requirements: Under this bipartisan proposal, insurers would not be able to waive the ACA preexisting conditions or ten Essential Health Benefits (EHBs), which became coverage requirements under the ACA, as previous ACA reform/replace bills have sought to do.
- Section 1332 Waivers Support: This proposal would streamline the waiver process and make it easier for states to acquire and maintain 1332 waivers. These allow states to implement their own health insurance programs as long as they meet thresholds for coverage and affordability that are similar to those achieved under the ACA.
Despite early support among both Democrats and Republicans in the Senate and pushing healthcare reform forward, last week President Trump signaled a singular focus on tax reform while meeting with Congressional leadership, suggesting there may not be a clear path forward. The Alexander-Murray proposal would also likely face an up-hill battle in the House where Majority Leadership is still focused on ACA repeal and replace. On October 25, the Congressional Budget Office (CBO) released an initial impact analysis of this proposal citing a deficit reduction of nearly $4 billion through 2027. Even with that news, the likelihood of this bill to move on its own appears slim; the most likely pathway for this proposal to become law, if at all, will be tacking it on to a “must pass” end of year funding bill.
Regardless of how – or when – the short-term stabilization package moves, the Administration’s announcement to end the CSR payments has already made an impact. Early estimates show that premiums for a silver-level plan in 2018 will increase 34%, higher than the average 25% increase we saw in 2017, and not all enrollees will qualify for the premium tax credits used to offset these market increases. Without CSR payments, insurers will also likely continue to exit ACA exchanges in many states, leading to states with fewer options and an unstable market overall. For cancer patients, and those battling chronic illnesses, efforts by the Administration to loosen regulatory requirements around comprehensive coverage and decisions to end critical funding streams to assist insurers in providing meaningful coverage for the costliest consumers is particularly troubling and will mean higher cost plans and fewer options.
And, amid all this uncertainty, Open Enrollment season is upon us. The Enrollment Period for ACA Exchanges has been scaled back to 45 days under the current administration, and will occur from November 1 through December 15, 2017.
ACCC will continue to monitor any legislative progress of the bipartisan market stabilization bill and continue to advocate for comprehensive, affordable insurance options for all cancer patients. For more on what ACCC needs to see in any ACA reform proposal, see our Health Reform Principles for Cancer Patients.