Will ACA Premiums Increase Over Congressional Disagreements?
Everyone in Washington wants to slash health insurance premiums under Obamacare, but key players can't seem to agree on the terms, leaving the push in jeopardy even as insurers try to size up the program and set rates for the coming year.
The White House has a list of demands it says must be in any bill Congress passes, including pro-life language that House Republicans have sought.
Democrats, meanwhile, want to boost taxpayer subsidies and allocate $100 million to promote the Affordable Care Act, hoping those changes would entice customers back into Obamacare's exchanges.
With midterm elections looming in November, polling suggests Republicans will take most of the blame if it rates go up.
Companies are expected to ask for price hikes this spring, citing lagging interest in the exchanges and Republicans' decision to repeal Obamacare's individual mandate, the law's main prod for herding more people into the market.
"Premiums are heading up in 2019 with the individual mandate being repealed, unless some intervention happens," said Larry Levitt, senior vice president at the Kaiser Family Foundation. "Many Republicans are resistant to doing anything that has the appearance of propping up the ACA, while Democrats don't want too many strings attached to any effort to stabilize the market and bring down premiums."
The impasse is bad news for several million people who buy insurance on their own but don't qualify for taxpayer-funded subsidies that make premiums affordable.
Insurers hope Congress will tie action to a looming March 23 spending deadline, when lawmakers are expected to pass an omnibus bill to fund the government for the rest of the fiscal year.
"Congress has an important opportunity to act and reduce premiums for consumers for 2019, but time is running short," the top insurers' lobby, America's Health Insurance Plans, said in a letter to House and Senate leaders this week.
Two bills are circulating.
One, negotiated by Sen. Lamar Alexander, Tennessee Republican and chairman of the Senate Committee on Health, Education, Labor and Pensions, and Sen. Patty Murray of Washington, the ranking Democrat on the committee, would restore cost-sharing payments to help insurers cover poor customers' out-of-pocket costs — something Democrats want. Republicans cheer the bill's waiver system that would let states experiment more with Obamacare-compliant plans.
The other bill, from Sen. Susan M. Collins, Maine Republican, and Bill Nelson, Florida Democrat, would spend billions of dollars in reinsurance money to subsidize extra-pricey customers.
"We've had very good conversations with the administration," Ms. Collins said.
A White House document, first reported by The Wall Street Journal, said efforts to use taxpayer dollars to prop up the markets must be coupled with items that "provide relief to middle-class families harmed by the law and protect life."
The administration would like to let insurers charge older customers up to five times what they charge younger ones — instead of Obamacare's 3-1 ratio.
It also wants to codify President Trump's regulatory push to let insurers sell short-term insurance policies that last up to a year instead of three months.
Sen. John Barrasso, Wyoming Republican, introduced a bill Wednesday that would do just that — and allow consumers to renew the plans, which don't have to satisfy the 2010 law's strict coverage guidelines.
The White House says it supports restoring cost-sharing payments that reimburse insurers for picking up low-income customers' costs, though only if they aren't used to help subsidize plans that cover abortion.
"While the decision for its inclusion has not been made, any appropriation for [cost-sharing] or reinsurance would need to be Hyde-compliant. That is not negotiable for House Republicans," said AshLee Strong, a spokeswoman for House Speaker Paul D. Ryan, Wisconsin Republican, referring to a recurring ban on using federal money for abortion.
The Republican Study Committee, an influential bloc of conservatives, has resisted any attempt to bolster Obamacare at all.
"We should be focusing on keeping our promises to the American people and repealing Obamacare, not stabilizing it," committee spokesman Alexei Woltornist said Wednesday.
House Democrats whose votes could be needed to pass a measure — should too many Republicans bail — have pushed back on pro-life demands or attempts to chip away at Obamacare.
For now, they are waiting to see what Republicans are willing to offer.
"We would like to get a number of these stabilization initiatives in the omnibus, but that's all I can say," said Rep. Frank Pallone Jr., New Jersey Democrat.
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