HELP committee's attempts at a bipartisan ACA fix at odds with Republicans' last-ditch repeal efforts

Lamar Alexander
Republican Senator Lamar Alexander, R-Tenn., has come under fire from his own party for efforts to create bipartisan legislation that would stabilize the ACA's individual marketplaces.

A Senate committee that wants to write bipartisan legislation to stabilize the ACA's individual marketplaces, add some certainty for insurers who offer those plans and keep premium costs down for millions of Americans is getting flak from both the left and the right.

The Senate HELP committee held four hearings with witnesses from healthcare industry organizations, including Kaiser Permanente and Anthem, Inc. They also heard from state insurance commissioners and governors from both sides of the aisle.

Although Democrat and Republican Committee members didn’t agree on all the finer details by any means, by the end of the hearings a general consensus seems to have emerged that some fixes—such as guaranteed cost-sharing reduction payments to insurance companies and more flexibility for states—could add some stability to the markets.

RELATED: Senate ACA stabilization hearings: State insurance commissioners talk reinsurance, CSR payments

Lamar Alexander, R-Tenn., the chair of the Senate Health, Education, Labor and Pensions committee, said he wants to bring bipartisan legislation out of the committee as early as this week.

But that goal is at odds with Republicans who are trying to take one last shot at repealing and replacing the Affordable Care Act. Without Republican support, any bill out of the HELP committee would be dead on arrival. 

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Alexander is “stealing our jurisdiction,” Senate Finance Chairman Sen. Orrin Hatch, R-Utah, told Politico. “It’s pretty hard to get excited about what he’s doing.” He also expressed skepticism about bipartisan fixes in a recent Washington Post op-ed

"Those who cheered for Senate Republicans to fail have been celebrating ever since, and we’re now hearing calls for bipartisan solutions," Hatch wrote. "While most reasonable people would welcome a bipartisan outcome to this mess, the solutions proffered thus far would do little more than shore up the bad policies already in place with another slate of bad policies. We need legitimate, long-term reforms."

But risk-averse health insurers, who must sign contracts by Sept. 27 in order to participate in the individual markets in 2018, want to see fixes now.

RELATED: 8 ways to fix the Affordable Care Act

Over and over, witnesses at the four HELP committee hearings stressed that without swift action, insurers could pull out of the markets—and those that remain in the markets will undoubtedly raise premiums without stabilization. 

Meanwhile, Democrats and Republicans on the HELP committee aren’t in total agreement on the fixes, either. For example, Democrats have vowed to protect essential health benefits, such as protections for patients with pre-existing conditions. And they're wary of giving states too much power to design benefits. 

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

And, as payers well know, not everyone is a big fan of insurance companies. 

Elizabeth Warren, D-Mass., called Anthem on the carpet for not stepping up for their members when Republicans were talking about repealing the ACA.

RELATED: Anthem has agreed to cover the 63 bare cities/counties in Virginia

“Instead, Anthem sent Congress a ransom note, saying it would begin to ‘surgically extract’ from the individual insurance markets if Congress didn’t meet a list of your demands, including tax cuts for insurance companies and the right to collect taxpayer money for selling junk insurance plans,” she said. “And to show you meant business, you pulled out of markets.”

She called out Anthem profits and noted how much of the company’s revenue comes from government plans, including Medicare and Medicaid (more than half this year).

The company gets “buckets of taxpayer money, yet you’re pulling out of the ACA market,” Warren said. “Can I ask why?”

Robert Ruiz-Moss, vice president of Anthem’s individual market segment kept calm and carried on. 

“We look at each market as its own insurance market and believe that the individual [market], in order to be successful, needs to stand on its own,” he said, adding that can’t happen without an “independent, stable, individual health insurance market.”

Yes, he said, Anthem looked across 14 states to determine where the company could make a go of it. “Because anywhere we can find stability, our inclination is to participate,” he said.

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