Q&A: New health bill offers stability, respite on premiums
WASHINGTON — The bipartisan health care bill formally proposed Thursday in Congress would help stabilize insurance markets up-ended by the fierce partisan battle over "Obamacare." For consumers, it offers a potential respite from the spiral of rising premiums and dwindling choice.
The legislation from Republican Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington is a political cease-fire that would send a reassuring message to insurers selling individual health policies to more than 17 million Americans.
Consumers who get subsidized get coverage under the Obama-era law — as well as those who don't get financial assistance from the government— would benefit, since the bill is expected to deter more insurers from exiting the market. That would maintain access to coverage.
But it seems unlikely that the legislation will provide relief from premium increases for 2018, already set in many cases. It does include a rebate mechanism for consumers.
Here are some questions and answers on the legislation:
Q: Health care is complicated, how would this bill change the landscape?
A: It continues for two years federal payments that reimburse insurers for reducing copays and deductibles for consumers with modest incomes. The Affordable Care Act requires insurers to provide the reductions, but federal reimbursement is under a legal cloud. President Donald Trump ended the payments, and insurers were formally notified of that this week.
Insurers, state officials, policy experts, and groups representing the business community, hospitals, and doctors say maintaining the payments will have a calming effect on premiums for individual plans, which are expected to go up by double-digits next year in many communities.
It may be too late for much of an impact next year, but premiums would stabilize in 2019.
The legislation also would provide $106 million in grants to states to encourage people to enroll for coverage. ACA sign-up season starts Nov. 1, and the Trump administration slashed the advertising budget.
Q: This is all about insurers, what's in the legislation for consumers?
A: If insurers end up collecting too much in premiums for next year, the bill provides for refunds to consumers and the government. A similar refund mechanism is part of the Obama-era health law, and has returned hundreds of millions of dollars annually to consumers.
Healthy individuals of any age who just want a skimpy plan to protect against the risk of an accident or unexpected illness would be able to buy lower-premium catastrophic policies.
States would not be able to obtain waivers that undercut consumer protections in the ACA, such as guaranteed coverage for people with medical problems and limitations on how much older adults can be charged.
Q: It sounds like somewhat modest legislation, is that about right?
A: Sen. Alexander called his bill a "first step" as he and Murray formally proposed it on Thursday.
Still, Larry Levitt of the nonpartisan Kaiser Family Foundation said there's symbolic importance to the legislation that can't be overstated.
"If Congress is able to work together in a bipartisan way to stabilize the insurance market, it might be the beginning of the parties being able to compromise on how to improve the ACA," he said.
Q: Improve "Obamacare"? That doesn't sound like "repeal and replace."
A: It's not.
But Republicans haven't been able to get very far on their seven-year promise of undoing Obama's health overhaul. Each time they've tried, their proposals have failed to win public support.
Alexander says Republicans wouldn't be giving up the fight for deeper "Obamacare" changes by supporting his bill. Indeed, he argues getting beyond crisis mode on health care might allow for more reasoned consideration of GOP ideas.
He and Murray lined up an equal number sponsors from each side of the political aisle for their legislation, 12 Republicans and 12 Democrats. Among them were GOP Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina, co-authors of the last ill-fated Republican effort to repeal "Obamacare."
Q: Does this bill give states the right to opt out of the ACA?
A: The Affordable Care Act already set up a process for states to get waivers to reconfigure their own health care systems using federal dollars, within the framework of the law. The Alexander-Murray bill streamlines that process, but it doesn't seem to give states leeway to change bedrock consumer protections.
Katherine Hempstead, who leads the Robert Wood Johnson's work on health insurance coverage, said if the bill advances she expects Republicans to push for more state flexibility.
"There will be attempts to pin things to the bill that bring it closer to a 'repeal and replace,' and that will create difficulties and make it more likely that the whole thing goes off the rails," she said.
Q: So what are the prospects for Alexander-Murray?
A: That seems to change by the day. Some conservatives have come out against it, and Trump has sent mixed signals. At first the president sounded supportive, then not so much.
The start of ACA sign-up season Nov. 1 could have an impact. By then, the government is expected to have released full details on premiums and insurer participation. If their constituents are left reeling from sticker shock, lawmakers may be pressed to act.
Q: And where will Trump come down in the end?
A: We'll see.