New doubts surface about Alexander-Murray bill

A bipartisan Affordable Care Act stabilization bill—ever on shaky ground—might now have a even slimmer chance of passing.

For one, the House released a year-end spending bill (PDF) on Thursday that does not include funding for cost-sharing reduction (CSR) payments, which is a key component of a measure drafted by Sen. Lamar Alexander, R-Tenn., and Sen. Patty Murray, D-Wash. 

RELATED: With House conservatives' resistance, ACA stabilization bills’ prospects get dimmer

The Senate could still add in all or part of the Alexander-Murray bill, but the argument to do so may not be as strong as the bill’s proponents think.

Here’s why: Many consumers will actually pay less for policies this year because subsidy amounts rose when insurers raised premiums to account for the disappearance of CSRs. So reinstating funding for CSRs—as the Alexander-Murray bill would do—could reverse that effect, experts told The Wall Street Journal.

As Kaiser Family Foundation Senior Vice President Larry Levitt put it, “the case for Alexander-Murray in terms of protecting consumers is much weaker than it was a few months ago.”

The fate of that bill—and a bill that would fund state-based reinsurance programs—is especially important since Sen. Susan Collins, R-Maine, has made her vote for the GOP tax bill contingent up including those measures in the year-end spending bill. Because the tax bill repeals the individual mandate, Collins hopes the two ACA stabilization bills will mitigate its negative effects.

RELATED: What health insurance executives think of the GOP's plan to repeal the individual mandate

The Congressional Budget Office, however, has advised that passing the Alexander-Murray bill wouldn’t change its prediction about the effects of repealing the individual mandate. The agency projected that axing the mandate would both decrease insurance coverage and raise premiums.

For her part, Collins said last week that she is confident that both the Alexander-Murray bill and the reinsurance bill she co-authored would make it into the final version of Congress’ year-end spending bill. Since Republicans now appear to have the votes to pass their tax bill, she will likely just have to take GOP leaders' word that they will honor the deal.