Bipartisan efforts in Congress to stabilize the Affordable Care Act’s (ACA) marketplaces came to an end this week as the negations took a decidedly partisan turn. Running against the clock to fund the government, Republican members of Congress threw a wrench into the negotiations by tying new abortion restrictions to funding that would go to insurance companies either through a reinsurance program or through cost-sharing reduction payments (CSRs) – the two centerpieces of the bipartisan negotiations.
Additionally, this week the Congressional Budget Office confirmed what consumer groups have warned – funding the CSRs without additional financial assistance would cause premiums to increase for many low-and moderate-income families who were able to access cheaper coverage this year thanks to the “silver load” workaround 36 states have employed. As a result, many more people would become uninsured.
Let the partisan games begin
Free from bipartisan constraints, Senators Alexander and Collins, joined by Representatives Walden and Costello, released their own version of a marketplace stabilization package on Tuesday afternoon. While it’s unlikely to be included in the bill to fund the government, there’s a chance Majority Leader Mitch McConnell may allow a vote on this bill in the Senate. This would be a purely political move aimed at forcing Senate Democrats to vote against a stabilization bill in the lead up to the 2018 elections. This bill does include some measures that would help reduce premiums next year, such as $30.5 billion in reinsurance funding over four years. However, it fails to account for the biggest threats to marketplace stability and comes at a cost: an unprecedented restriction on access to abortion coverage in marketplace plans and premium increases for moderate-income consumers that would lead to coverage losses.
Where the Republican plan falls short
The ACA already includes a provision (the Nelson Amendment) to prevent the use of federal funds for abortion services, except in the cases of rape, incest or if a women’s life is in endangered. Republicans asking for new abortion coverage restrictions in the stabilization bill claim it is no different from how these restrictions are currently applied to the ACA and other programs today. However, a closer look reveals this isn’t business as usual. Currently, plans sold on the marketplace and other federal coverage programs like Medicaid can offer plans covering abortion services as long as non-federal dollars cover this portion of the coverage. In the case of this bill, because CSR payments and reinsurance funding don’t have a non-federal funding component, if a plan selling coverage on the marketplace covers abortion services it would likely be ineligible for CSR payments and reinsurance funds. This restriction would likely lead to few, if any, options for abortion coverage in the individual market.
While the abortion coverage restrictions provide a clear line in the sand for most Democrats, that’s not the only issue standing in the way of this bill. Because states’ silver loading strategy resulted in larger premium tax credits for eligible consumers, which allowed them to enroll in cheaper and in some cases more generous coverage for 2018, funding the cost-sharing reduction payments today would reverse this outcome and actually increase premiums for many consumers shopping for similar coverage next year. Coupled with the loss of the individual mandate and this bill’s failure to address the Trump Administration’s proposal on short-term plans, these premium increases would result in coverage losses, as the CBO concluded. This combined impact arguably negates any stabilizing influence the bill’s other provisions, such as reinsurance, might have.
Democrats offer a recipe for stabilization and consumer protections
A far cry from the current debate, members of the Democratic caucus in both the House of Representatives and Senate recently introduced bills with a clear vision of how Congress could make improvements to the ACA. Each of these bills has its own flavor. Democratic leaders in the House introduced a bill focused on improving affordability and undoing Trump administration sabotage efforts. Senator Baldwin introduced a bill that aims to block junk insurance plans and protect people with preexisting conditions. Yesterday, Senators Warren, Sanders, Harris, Gillibrand, Hassan and Baldwin threw their hat in the ring introducing the Consumer Health Insurance Protection Act that would address consumer protections ranging from affordability to access to comprehensive coverage.
Community Catalyst’s federal agenda for building on the foundation of the ACA to improve coverage and affordability shares many of these same goals and policy solutions. While these efforts are unlikely to attract bipartisan support anytime soon, they serve as an important marker for what Congress must do to tackle the important issues consumers face in the health care market today. Using these bills as a guide, if Congress wanted to pass a bill that would truly stabilize the market and address consumers’ top concerns, such as the affordability of coverage, the recipe for stabilization this year would look something like this:
- Provide additional financial assistance that would allow more people to be eligible for tax credits and plans with lower cost sharing, as well as offer more generous financial assistance for low-and-moderate income people who are currently eligible.
- Block junk insurance plans that will cause premiums to increase for people with preexisting conditions who rely on comprehensive coverage sold on the marketplaces.
- Fund a reinsurance program that has bipartisan support and will bring down premiums in the marketplaces by offsetting the costs for insurers who enroll high-risk enrollees.
- Restore funding for outreach and enrollment to ensure that consumers have the help they need to enroll in coverage that meets their needs.
As the old adage goes, where there’s a will there’s a way. In this case, the way is pretty clear – Congress just needs to find the will.