Governors share health plan as Senate flirts with bipartisanship

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(Bloomberg) — A bipartisan group of eight governors is calling for changes to the Affordable Care Act that would increase funding under the law, enforce some of its rules on buying insurance and encourage more health insurers to participate in the program.

The proposal, led by Ohio Republican John Kasich and Democrat John Hickenlooper of Colorado, comes as premiums under the program continue to rise in many states and as insurers have pulled out.

“We need immediate action to ensure consumers have affordable options in the short term,” the governors said in the letter, which was sent to Democratic and Republican leaders of Congress. “Continuing uncertainty about the direction of federal policy is driving up premiums, eliminating competition, and leaving consumers with fewer choices.”

Republicans’ failed efforts to make broad changes to the Affordable Care Act have now shifted to smaller, potentially bipartisan reforms. The governors, in their letter, avoid one of the most contentious parts of the repeal debate earlier this year -- Obamacare’s expansion of Medicaid to millions of more low-income Americans -- because they said the market for individual coverage needs to be fixed first.

Obamacare relies on private insurers to offers coverage in online marketplaces known as exchanges. It provides subsidies to many consumers. But many insurers have taken losses in those markets markets.

They’ve also struggled to deal with President Donald Trump’s threats to undermine the law or push it toward failure. Insurers’ retreat has left almost a quarter of enrollees with just one insurance-company option next year, according to data compiled by Bloomberg.

Push for changes
Kasich has been vocal about making changes to the ACA rather than repealing it.

He worked with a group of Republican governors earlier this year to come up with a proposal to preserve the ACA’s Medicaid expansion, proposing a flexible per-person funding system that would accommodate any sudden influxes of Medicaid enrollees, for example during a recession.

The new proposal released Thursday includes:

  • Funding Obamacare’s cost-sharing reduction subsidies.
  • Providing additional funding to help insurers deal with high-cost patients.
  • Giving tax breaks to insurers that enter counties with only one insurance option, or letting individuals in those counties purchase federal employee insurance plans.
  • Maintaining Obamacare’s requirement that all individuals purchase insurance or pay a fine, at least until a replacement can be put in place.

Senate hearings
Next week, senators will hold a series of hearings on how to stabilize the law’s markets -- a part of the legislative process they largely avoided in the brief run-up to their repeal efforts. Lawmakers may also look for a way to ensure payment of subsidies under the law that help defray out-of-pocket costs for low-income Americans.

Known as cost-sharing reduction subsidies, or CSRs, the payments are the subject of a legal dispute and the Trump administration has threatened to stop paying them, which would cause further disruption to the insurance markets. Funding them is a Democratic priority while Republicans will push for flexibility for states to obtain waivers to make changes to Obamacare.

The letter, dated Aug. 30, was also signed by: Brian Sandoval (Nevada, Republican); Tom Wolf (Pennsylvania, Democrat); Bill Walker (Alaska, Independent); Terence McAuliffe (Virginia, Democrat); John Bel Edwards (Louisiana, Democrat); and Steve Bullock (Montana, Democrat).

Bloomberg News
Healthcare reform Obamacare Healthcare-related legislation Federal health insurance exchanges