On October 17, 2017, U.S. Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) announced an agreement in principle on a bipartisan bill that is under consideration within the Senate Committee on Health, Education, Labor, and Pensions. If enacted, the bill would:
• More clearly authorize Federal funding under the Affordable Care Act (ACA) for cost-sharing reductions (CSRs) in 2018-2019 for certain individuals, with incomes 100-250 percent of the Federal poverty level, who purchase coverage through health insurance Exchanges. This provision of the bill would resolve a three year lawsuit (House v. Burwell, 2014) which has destabilized health insurance markets and spurred increases in health insurance premiums due to insurers’ uncertainty about over $7 billion/year in continued Federal payments for CSRs.
• Allow purchase of high-deductible, low-premium coverage plans for certain individuals outside of age and income parameters for such plans in the ACA, such as individuals over age 30 and individuals not meeting certain financial hardship criteria.
• Restore over $100 million in Federal funding under the ACA for 2018-2019 Exchange outreach and enrollment activities.
• Amend criteria and procedures for Federal approval of waivers for state innovation under section 1332 of the ACA. These would include shorter Centers for Medicare and Medicaid Services (CMS) waiver application review periods, expedited CMS reviews for waivers in emergencies identified by states, automatic CMS approvals if states adopt models CMS approved for other states, and new criteria on “comparable affordability” of coverage for low income households.
• Offer states additional funding flexibility to create reinsurance, high risk pools, and insurance stability funds.
• Direct CMS to issue new regulations to implement section 1333 of the ACA, which already permits interstate compacts on selling health insurance across state lines.
Many other ACA provisions would be unchanged by this important new bill. PCG will provide updates as additional information becomes available.