It is back-to-work time for members of Congress, as they return to DC and turn their attention to a lengthy to-do list that includes critical items related to the budget and health care, among other things. By the end of September, Congress must pass a Continuing Resolution (CR) in order to fund the government and avoid a shutdown, and must raise the debt ceiling to avoid defaulting. These budget debates will be further complicated by the urgent need for relief funding due to Hurricane Harvey (and, potentially, Irma…). As if this to-do list wasn’t long enough for September, the Senate parliamentarian announced last week that the vehicle Congress has been relying on in their effort to repeal the Affordable Care Act (ACA) and gut Medicaid — reconciliation — will expire at the end of this month. This means that after September 30, Congress will either need 60 votes and Democratic support for a health care reform bill or it will need to approve a new budget resolution for fiscal year 2018 that includes instructions to repeal the ACA.

Senate HELP Committee Hearings: What to Expect

As the window on repeal narrows, we are glad to see that some members of Congress have turned their attention to bipartisan heath care efforts. Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) of the Senate Health, Education, Labor and Pensions (HELP) committee today begin a series of bipartisan hearings focused on stabilizing the ACA marketplaces. Today and tomorrow, the committee will hear from a bipartisan group of governors and insurance commissioners representing Oklahoma, Washington, Pennsylvania, Alaska, Tennessee, Massachusetts, Utah, Montana and Colorado. In subsequent hearings next two week, they will hear from a variety of witnesses including representatives from hospitals and insurance companies.

Chief among the issues in front of the committee is the need to permanently fund the cost-sharing reduction (CSR) program, an issue that has caused volatility in the ACA marketplaces this year and is the primary factor driving premium rate increases for 2018. We expect a relatively unified voice from both members of Congress and witnesses with a desire to alleviate uncertainty over the CSR payments; however, while a permanent solution would be ideal there’s a real possibility that a deal could ensure payments through 2018 and then kick the can on future plan years. This would bring stability in the short-term but set up another battle over CSR payment uncertainty next year.  

Bipartisan Proposals: What to Watch Out For

Beyond CSRs, it’s unclear how much the HELP committee will be able to tackle this month, but that isn’t stopping key stakeholders from sharing their ideas. Notably, last week Governors John Hickenlooper (D-CO) and John Kasich (R-OH) released new plan for bipartisan marketplace stabilization signed by six more governors–Gov. Brian Sandoval (R-NV), Gov. Bill Walker (I-AK), Gov. John Bel Edwards (D-LA), Gov. Tom Wolf (D-PA), Gov. Terry McAuliffe (D-VA) and Gov. Steve Bullock (D-MT). This blueprint includes several key recommendations that would bring more stability to the ACA marketplaces in the short-term including funding for CSRs, a stability fund to be used for state reinsurance efforts and ideas for increasing plan competition so that consumers have more coverage options for 2018 and beyond. While the proposal is very positive on balance, some details do raise concerns, including recommendations to provide additional flexibility to states on defining Essential Health Benefits and 1332 waivers.

Overall, the bipartisan hearings and stakeholder input are a step in the right direction toward finding viable solutions to help stabilize the marketplaces, increase competition, and bring down costs for consumers. As consumer advocates, we will be watching Congress this month to ensure that the HELP committee and the rest Congress stays focused on improving the ACA, not undermining it. Any future action on health care reform should pass the following test to defend and improve access to affordable health care for all:

  • Protect Medicaid funding and reject proposals to cap or cut federal Medicaid funds.
  • Increase the number of insured individuals.
  • Maintain or improve consumer protections such as essential health benefits, non-discrimination requirements and protections for people with preexisting conditions. 
  • Increase affordability for consumers by decreasing out-of-pocket expenses and improving financial assistance.