At the Senate health committee’s fourth health care hearing this month, Chairman Lamar Alexander said that "it’s clear to truly protect patients, we need to stabilize the markets, limit premium increases, and begin to lower premiums in the future."
“For seven years, hardly a civil word was spoken between Republicans and Democrats on the Affordable Care Act,” Senator Alexander said. “But for the last 10 days, senators from both sides of the aisle have engaged in serious discussions about what Congress can do between now and the end of the month to help limit premium increases for the 18 million Americans in the individual health insurance market next year and begin to lower premiums after that, and to prevent insurers from leaving the markets where those 18 million Americans buy insurance.”
The committee met to hear testimony from a state insurance commissioner, an insurer, a patient advocate and doctors on what could happen to patients if Congress does not reach a compromise.
Senator Alexander said, “During our first three hearings, three themes emerged that represent a working consensus for stabilizing premiums in the individual market for 2018.
First, is Congressional approval of continued funding of the cost-sharing payments, for a specific period of time, that reduce co-pays and deductibles for many low-income Americans on the exchanges. Second, senators from both sides of the aisle suggested expanding the so-called ‘copper plan’ already in the law so anyone—not just those 29 or under—could purchase a lower premium, higher deductible plan.
“The third – advocated by state insurance commissioners, governors, and senators from both sides of the aisle – is to give states more flexibility in the approval of coverage, choices, and prices for health insurance. Most of the discussion about flexibility has centered on amending the section 1332 state innovation waiver, because it is already in the Affordable Care Act, including commonsense suggestions to improve and speed up the process to make the 1332 waivers easier for states to use.”
“At Tuesday’s hearing on state flexibility, witnesses discussed how to amend the 1332 waiver to give states the authority to offer a larger variety of health insurance plans with varying benefits. Several witnesses suggested that ‘actuarial equivalency’ is a useful way to do that. Governor Michael Leavitt, former Secretary of Health and Human Services, suggested that with this approach plans be of equal value but wouldn’t have to be carbon copies of one another. He used a car as an example. He said, "If you looked at several $25,000 cars, one might have a backup camera, one might have a stronger horsepower, but it’s still a $25,000 car. So health plans might have different benefits, but they’d have to be of the same value to the consumer.”
Senator Alexander said, “I want a result that gives states flexibility in the approval of coverage, choices, and prices for health insurance. I simply won’t be able to persuade the Republican majority in the Senate, the Republican majority in the House, and to the Republican president to extend the cost-sharing payments without giving states meaningful flexibility. It’s clear to truly protect patients, we need to stabilize the markets, limit premium increases, and begin to lower premiums in the future."
The committee met last Wednesday to hear from state insurance commissioners, last Thursday to hear from governors, and on Tuesday to hear from state flexibility experts.
Alexander’s full prepared remarks are here.