States look to Alaska as Senate attempts to shore up individual health insurance markets
Talk of more certainty in federal funding, expanding a state waiver program and potentially allowing buy-ins for a federal marketplace comes as other states struggle to replicate
Though Wednesday's hearing before the
"I think we can get those specifics worked out within the next week and a half here," she said. The goal is first to shore up struggling individual markets, she said. Subsequent steps will focus on reducing the overall cost of health care.
Committee Chairman
The committee's top Democrat, Sen.
All is not rosy in
Wing-Heier joined insurance chiefs from
Wing-Heier didn't just speak to the HELP Committee members Wednesday. Earlier, the committee invited those testifying to a morning coffee with whichever senators wanted to come. Thirty-one of them showed up.
"It was very good. It was informal," Wing-Heier said. "There were a lot of questions for all five of us about what we needed to see in market stability from reinsurance to the cost sharing, health care, pharmaceuticals, much like you heard today but in a less formal setting."
A top issue that the committee members hope to resolve this month is how to manage cost-sharing reduction (CSR) payments -- the federal funding to insurance companies that's designed to keep premium costs down.
Across the board, commissioners told the senators that they want to see certainty in CSR payments. President
The idea of funding longer-term CSR payments has more bipartisan support than most options, so it's a likely candidate for any targeted legislation in the near-term. How long
In
Wing-Heier told the panel that the CSRs need to be authorized for at least two years to get a solid commitment out of insurers. She also said that she expects to see another insurer enter
Murkowski was confident about prospects for a bipartisan consensus on CSRs.
"I think the issue will be how long that is, whether it is one year, two years or perhaps longer-term," she said after the hearing.
Throughout the hearing, Wing-Heier and
Wing-Heier explained how it works to the committee members Wednesday: The state put out a call for data from its only remaining individual market insurer -- Premera -- and determined which conditions were skewing the treatment costs and bringing up costs for everyone in the pool. With fewer than 20,000 people in the market, a few ill members can make the market unprofitable for everyone else.
Wing-Heier and her cohorts in the Walker administration convinced the state Legislature to let them shift insurance tax revenues from the general fund to a program that would cover those conditions. In 2017, with
The sweetener for the state Legislature: a then-little-known part of the Affordable Care Act known as the "1332 waiver." It allowed states to shift federal funding to any innovative program that brought down premium prices.
When
It took
More than 20 states have begun the process to apply for 1332 waivers now. Only
Other states are going to have a "tough hurdle," Wing-Heier said, particularly getting approval from state legislatures to apply for a waiver.
"We've talked to probably 40 states, and all would like to be able to do something like
Senators asked a lot of questions about reinsurance at the hearing -- and broadly heard from the state commissioners that they need authority to apply for it without legislative approval. Wing-Heier also suggested speeding up the approval process. Others asked for funding to cover the application process and the ability to combine waivers for the individual market and Medicaid programs.
Not everyone is sure that waivers are the right choice.
"We should have the opportunity to do something different," he said. "I do not think the government will ever fix health care. The markets will."
Lawmakers also seemed primed to consider allowing alternate types of individual plans.
Upon questioning from
Murkowski -- who, along with ultimately voting against "Obamacare" repeal, has been a strong proponent of having bipartisan hearings -- questioned whether there is a long-term workable plan, given such a small individual market in
"When you have markets that are under-served ... is it possible to have an option or an opportunity to buy into another system?" Murkowski asked in an interview after the hearing. A group of governors, including
During the hearing, Murkowski and Wing-Heier both spoke about the oft-mentioned prospect of buying insurance across state lines, which they agreed is an unlikely option for
Wing-Heier also told the panel that
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