WASHINGTON - After denouncing the Affordable Care Act as an abomination for seven years, Republicans in Congress, working with the Trump administration, are urgently seeking ways to shore up health insurance marketplaces created by the law.
While President Donald Trump said as a candidate that "Obamacare is certain to collapse of its own weight," Republicans fear such an outcome because, now that the fate of the health law is in their hands, they could be blamed by consumers and Democrats.
The Republican proposals address concerns that insurers have been expressing for several years, among them what they call costly abuse of special enrollment periods. But markets could still be undermined, insurers say, if Congress simultaneously repeals the health law's requirement for most Americans to have coverage.
That requirement, known as the individual mandate, is one of the more unpopular features of the law, signed in 2010 by President Barack Obama. But insurance companies like it because it requires people to buy their product, bringing in healthy people who pay premiums and do not use much care.
Analyzing the Republican strategy, Joel L. Michaels, a health lawyer at the firm McDermott Will & Emery, said there was "a tension" between efforts to repeal the health law and shore up its insurance marketplaces, where more than 10 million people obtained coverage last year.
"A political agenda premised on the Affordable Care Act being unworkable could conflict with efforts to support the ACA exchanges, even on an interim basis," Michaels said. "How far do you go with short-term fixes, which could make the law work better in the long term? It's a delicate political dance."
Insurers are seeking immediate governmental action because they must decide by early May what kinds of health plans they will offer on the exchanges in 2018.
The proposed rule drafted by the Trump administration and one of the bills drafted by House Republicans would make it more difficult for consumers to obtain insurance outside the annual open enrollment period. Under existing rules, people can sign up after the deadline if they experience certain "life changes."
Under another Republican proposal, it would be easier for insurers to terminate coverage for people who fail to pay their premiums. Meanwhile, Republicans in Congress are warming to the idea of continuing payments to insurance companies to help cover the out-of-pocket costs for people with low incomes, at least temporarily.