House GOP floats 'invisible risk-sharing program' amendment to stalled healthcare bill

Paul Ryan speaking
House Speaker Paul Ryan, under pressure from the White House to make progress on repealing the ACA, unveiled an amendment to the American Health Care Act on Thursday. (Gage Skidmore/CC BY-SA 2.0)

Republicans’ prerecess scramble to make progress on their tabled healthcare bill resulted in the introduction of a new amendment Tuesday that they hope will get them closer to agreeing on how to repeal and replace the Affordable Care Act.

The amendment, a copy of which was obtained by Vox, would create a “federal invisible risk-sharing program” that would provide payments to health insurers to help them pay the claims of their most expensive individual market members, with the goal of lowering premiums for all customers.

To do so, it would allocate $15 billion in federal funding over nine years, with the federal government administering the program for the first three years and allowing states to take over after that.

At a news conference Thursday, House Speaker Paul Ryan said he has asked the House Rules Committee to mark up the amendment and add it to the American Health Care Act. He said the amendment, which was authored by House Freedom Caucus members Gary Palmer and David Schweikert, “brings us closer to the final agreement that we all want to achieve” of repealing and replacing the ACA.

The idea was based on “a great model [that] comes out of the state of Maine, where it has lowered premiums and it has increased enrollment,” House Energy and Commerce Committee Chairman Greg Walden, R-Ore., said.

In fact, Joel Allumbaugh, Tarren Bragdon and Josh Archambault—all of whom are affiliated with right-leaning advocacy group The Foundation for Government Accountability—touted the success of Maine’s “invisible high-risk pool” in a Health Affairs Blog post published in March.

“If federal funding for state-run risk management programs is included in an ACA replacement plan, Maine’s assessment formula presents a model that could be utilized to develop a federal funding formula that is simple, targeted, unambiguous and encourages insurer participation,” they wrote.

But the proposal is not all that different from the ACA’s reinsurance program, a Bloomberg article points out. That program, which ran through 2016, reimbursed a portion of insurers’ spending on high-cost enrollees. A recent study indicated that it and the permanent risk adjustment program helped even the playing field for insurers in the ACA’s first two years of implementation.

Progress, but is it enough?

GOP leaders speaking at Thursday’s press conference were careful to point out that while they think the amendment is a step forward, their work to build consensus on a healthcare bill is not done.

“While we have work to do to get all the way there, we have made some real progress this week,” Ryan said, later adding that “we are well within that spectrum of timeline that we envisioned in dealing with the Obamacare legislation.”

At a question-and-answer session on Wednesday with WisPolitics, Ryan made a similar point, saying “We can keep working this for weeks now, we don’t have some kind of artificial deadline in front of us.”

Yet a report from Politico belies Ryan’s calm words, highlighting just how much pressure he is under from an impatient White House.

A meeting got heated Wednesday between House GOP leaders and top aides to President Donald Trump, sources told the publication, with the latter leaning hard on Ryan to hold a vote on a bill this week. "They were in total meltdown, total chaos mode,” one source told Politico.

Editor's note: An earlier version of this article misstated how many years the invisible risk-sharing program would last. It would last for nine years.