Alexander Says 2018 Health Insurance Compromise That Includes Cost-Sharing Payments Must Include Flexibility For States

Tuesday, September 12, 2017

At the third of four Senate health care hearings this month, held to hear testimony from state flexibility experts, Chairman Lamar Alexander said that any health insurance compromise for a stability bill including cost-sharing payments must also include real flexibility for states.

“The individual market is where 18 million Americans buy their insurance, “Senator Alexander said, “The cost of premiums, co-pays and deductibles have been skyrocketing in many states.

Half of these 18 million Americans have government subsidies to help cushion the blow of these rising prices. Many who find themselves in the other half are being priced out of the insurance market. They just can’t afford it.

“Despite our partisan differences, our two hearings last week demonstrated a real hunger by many senators on both sides of the aisle to come to a result. Three themes emerged during those hearings and I believe they represent a working consensus for stabilizing premiums in the individual insurance market in 2018. First, Congress should approve continuing funding of the cost-sharing payments that reduce co-pays and deductibles for many low-income Americans who buy insurance on the exchanges.

“The second theme came from senators on both sides of the aisle to expand the so-called 'copper plan' already in law, so anyone – not just those 29 or under – could purchase a lower premium, higher deductible plan that keeps a medical catastrophe from turning into a financial catastrophe.

“Third, advocated by state insurance commissioners, governors, and senators from both sides of the aisle, was to give states more flexibility in the approval of coverage, choices, and prices for health insurance.

“Most of the discussion about flexibility last week centered on giving states greater flexibility by amending section 1332—the state innovation waiver provision that is already in  the Affordable Care Act. We heard from virtually every witness last week that an application for the section 1332 waiver is too cumbersome, inflexible, and expensive for states – even though 23 states have taken steps to start the process so far, only two have succeeded. One part would be to make it easier for states to do what Alaska has done, and what Minnesota, Iowa and Maine are considering doing. 

“Another part is to give states more authority to offer a larger variety of health insurance plans that would give individuals the opportunity to have a more personalized health insurance plan. We heard from several witnesses that the current rules on what types of health insurance can be offered under 1332 waivers are so rigid that a state essentially can’t offer anything but an existing Affordable Care Act exchange plan. This would be like a restaurant menu with only one item, or a travel agency with only one destination, or if Dr. Seuss had written a book titled ‘Oh, The Place You’ll Go.’”

On Thursday, the committee will meet to hear from a state insurance commissioner, doctors, and patient advocates. The committee met last Wednesday to hear from state insurance commissioners and last Thursday to hear from governors

Alexander’s full prepared remarks here.


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