Senate committee closer to bipartisan ACA fix, but devil's in the details; Kaiser CEO Bernard Tyson makes a promise

Lamar Alexander
Senate HELP Committee Chair Lamar Alexander expressed support for some of the ACA's "guardrails," including protection for patients with preexisting conditions and rules against lifetime health insurance caps.

Members of a Senate committee are moving closer to creating bipartisan legislation to stabilize the individual insurance markets, but they’re mostly split along party lines over the finer points—including how long the stabilization measures should be in place.

A prime example: There’s consensus that payers need the government to continue funding cost sharing reduction (CSR) payments, which the Trump administration has threatened to cut off.

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Several witnesses who came before the Senate Health, Education, Labor and Pensions committee in the first three of four hearings stressed that insurers, already making plans for 2019, need at least a two-year guarantee.

Committee Chairman Sen. Lamar Alexander, R-Tenn., said he’ll support a single year fix, while Sen. Patty Murray, D-Wa., the committee’s ranking member, called for a "multi-year" fix.

CSR payments—or the lack thereof—will have the biggest impact on the rates payers set for 2018. Those rates are due to state insurance commissioners by the end of this month.

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There also seems to be a consensus that states should have more flexibility to design their own fixes and choose what programs are best for their own patient populations.

But, again, it’s a matter of degrees. Republicans are more bullish on loosening ACA regulations than Democrats, who want to protect so-called “guardrails,” minimum requirements for any state requests for ACA waivers.

Although there have been reports that Democrats are worried that their peers on the other side of the aisle are pulling the negotiations in a more conservative direction, Alexander continued to stress that the “partisan political stalemate” is a big problem.  

RELATED: State insurance commissioners talk reinsurance, CSR payments at Senate HELP hearing

Lamar expressed support for some of those guardrails and other parts of the ACA. “I’m not proposing we change” protection for patients with pre-existing conditions, allowing young adults to stay on their parents’ health plans, guaranteeing consumers the right to buy health insurance or regulations against annual limits, he said.

As the CEO of Kaiser Permamente, which has both a payer and a provider arm, Bernard Tyson was the first—and only—industry witness at the three hearings the committee has held so far.

Not surprisingly, he urged the committee to guarantee “multi-year” CSR payments, to enforce the ACA’s individual mandate, to continue funding marketing and outreach programs and to repeal the unpopular insurance tax.

But Tyson also spoke at yesterday's hearing about what payers would give in exchange for those stabilization efforts.

“In return I will recommend that you demand ... my colleagues [and I] step up to the plate. I can tell you with certainty that many will get back into the market. You don’t have to take my word alone, call them directly,” he said, adding that he has already made calls and that high-profile payer CEOs including Anthem's Joe Swedish and Cigna's Mark Bertonlini agree.

The fourth and final hearing is Thursday at 10 a.m. and the committee will hear from payer and provider leaders, including Susan L. Turney, M.D., CEO of Marshfield Clinic Health System and Robert Ruiz-Moss, vice president of Anthem’s individual market segment.

Follow FierceHealthPayer (@HealthPayer) on Twitter for live event coverage.