Editor's note: This story has been updated to include a response from the White House.
The Trump administration wants to include several policies favored by conservatives—such as charging older people higher premiums—in any ACA stabilization legislation that comes out of Congress, according to an internal memo.
The document (PDF) includes three provisions the White House wants added to any bill that aims to stabilize the Affordable Care Act's insurance markets. These reforms, according to the administration, would "provide greater choice and control for middle-class families."
The memo says bills should:
- Include language that codifies a recent proposal from the Department of Health and Human Services to extend the enrollment period for short-term insurance plans.
- Expand access to health savings accounts.
- Allow insurers to charge older people up to five times more than younger people in the individual and group markets.
In addition, President Donald Trump backs congressional proposals to fund cost-sharing reduction payments beyond 2018, according to the document.
"The White House has transmitted legislative ideas that reduce health insurance premiums, expand affordable coverage options, lower overall Obamacare spending, and ensure taxpayers are not forced to subsidize abortions," Deputy White House Press Secretary Hogan Gidley said in a statement to FierceHealthcare.
"While some in Congress might advocate using taxpayer money to shore up Obamacare exchanges, if there are no reforms that provide relief for middle-class Americans, such measures would just be a bailout of a failed government program," Gidley said.
Republicans have long called for changes to the ACA's rate-banding rule, which limits insurers to charging older people premiums that are three times higher than younger people. Bumping the rate to 5:1 was a proposal included in the House of Representatives' ill-fated American Health Care Act from last year.
The GOP has also long backed increasing access to health savings accounts as a way to ease patients' healthcare cost concerns.
HHS unveiled its plan on Feb. 20 to expand the enrollment period for short-term insurance plans from three months, the limit set by the ACA, to twelve months. Industry experts have argued that the proposal would encourage healthy people to leave the markets, raising premiums.
Although the memo supports those initiatives, an HHS spokesperson told FierceHealthcare that the agency does "not comment on alleged, leaked documents."
Bipartisan ACA stabilization talks have been ongoing over the past several months, with multiple bills in play to lower premiums in the individual marketplaces.
Sen. Patty Murray, D-Wash., co-author of one of the bills alongside Sen. Lamar Alexander, R-Tenn., criticized the memo's proposals in a statement to The Wall Street Journal.
"I certainly hope the president and Republican leaders won't once again sabotage an opportunity to undo some of the damage they've done by choosing to play politics with women's health and making last-minute, harmful demands," Murray said.