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Life Health > Long-Term Care Planning

Trump Praises Deal to Trade Temporary ACA Cash for State Flexibility

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President Donald Trump today praised a new Affordable Care Act stabilization bill Sen. Lamar Alexander, R-Tenn., is preparing to introduce together with Sen. Patty Murray, D-Wash.

“This is a short-term deal,” Trump said. “The solution will be for one or two years.”

He said the deal could shore up the health insurance market while Congress completes work on a long-term solution.

Alexander, the chairman of the Senate Health, Education, Labor and Pensions Committee, said on the Senate floor that he will join with Murray, the highest-ranking Democrat on the committee, to roll out their bipartisan ACA rescue bill later this week.

The bill would appropriate enough funding to keep the ACA cost-sharing reduction subsidy program going in 2018 and 2019, Alexander said.

(Related: Trump Is Open to an ACA Deal With the Democrats: Lamar Alexander)

In exchange, ACA supporters would have to accept some weakening in the “guardrails,” or coverage quality and access standards, that President Barack Obama’s administration established for the ACA Section 1332 waiver program.

At press time, the text of the proposal was not available.

An Ordinary Bipartisan Bill

Republicans hold a strong majority in the House but just 52 seats in the Senate.

In recent months, Republican congressional leaders have focused on drafting Republican-only Affordable Care Act budget reconciliation measures. Under Senate rules, a budget bill can deal only with budget matters, but it can get through the Senate with support from just 50 senators. The Senate can use the budget reconciliation process to pass just one budget deal per year.

An ordinary bipartisan bill would need a total of 60 votes to get through the Senate, including a combination of both Republicans and Democrats.

Alexander has been working on a bipartisan bill with Murray for months. Their Senate HELP Committee held four hearings on stabilizing the individual major medical insurance market, including the Affordable Care Act public exchange system, in September.

Alexander said today on the Senate floor that one advantage of considering an ordinary bipartisan bill is that the bill can change Affordable Care Act matters other than budget provisions, such as Affordable Care Act program rules.

Alexander and Murray will face two major obstacles, however.

They will have to persuade a significant number of Republicans in the House to vote for a bill that would continue a major Affordable Care Act funding stream.

Even if Alexander and Murray can get attract a majority of the members of the House, and 60 senators in the Senate, they will also have to get enough Republican, and Republican leadership, support to have their bill come up for a vote on the floor of both the House and Senate.

Alexander said he would introduced the bill together with Murray and other colleagues.

He did not say how many Republican cosponsors he expects to have in the Senate, or how much Republican support he expects to have in the House.

Gatekeeper Reactions

Senate Majority Leader Mitch McConnell has supported the Alexander-Murray negotiations in the past but has not given a clear statement of his views on the deal announced today.

In the past, House Speaker Paul Ryan has appeared to side with Republicans working on Republican-only proposals. He has not made a clear statement about the new proposal.

President Donald Trump (Photo: White House)

President Donald Trump (Photo: White House)

Two lawmakers who said in the spring that they wanted to move the House toward approving the most conservative possible Affordable Care Act change bill gave different responses to the Alexander-Murray proposal.

Rep. Mark Meadows, R-N.C., the chairman of the House Freedom Caucus, called the proposal “a good start.”

“There are elements in the Alexander-Murray plan that we can build on, but much more work needs to be done,” Meadows said in a statement.

Rep. Mark Walker, R-N.C., chairman of the Republican Study Committee, rejected the proposal, calling it a bailout proposal.

The president was openly supportive. During a press conference outside the White House, he described the Alexander-Murray as a bridge toward repealing and replacing the Affordable Care Act.

Supporters of a broader, long-term proposal for changing the Affordable Care Act are close to getting the votes needed to pass that, and they’ll soon have the votes to make that happen, Trump said.

Section 1332 Waiver Program

The Section 1332 waiver program gives a state a chance to adjust ACA rules.

Under the Obama administration, regulators ruled that a state could get a waiver only if an adjustment would meet include a long list of guardrail standards. Under the guardrail rules, a waiver change cannot lead to cuts in benefits, or any reduction in coverage access, for any group of people.

The Obama administration also established a long, complicated Section 1332 waiver application process, without providing a standardized application form.

Alaska has used a waiver to set up an individual market reinsurance program, and Hawaii has used a waiver to replace its Affordable Care Act small-group health insurance exchange program with a state small-group health coverage subsidy program.

Minnesota recently received permission to set up a reinsurance program similar to the Alaska reinsurance program.

No other state has received a waiver approval.

Iowa, for example, has proposed filling any void in Affordable Care Act exchange plan coverage for its residents by setting up a temporary state-negotiated, state-managed coverage menu program. Iowa has received a letter stating that its application is complete, but it has not received official approval for the proposal from the U.S. Department of Health and Human Services.

Alexander argued that the current version of the waiver program is too restrictive.

“It’s as if you can drive anywhere in the United States, as long as you end up in New York, Nashville or Alabama,” Alexander said.

Alexander said that, in addition to providing cost-sharing reduction subsidy funding and easing Section 1332 waiver program rules, the Alexander-Murray bill would:

  • Help states set up multi-state health insurance product compacts, so an insurer could sell the same compact plan throughout a compact region.

  • Double marketing support for for 2018, and make the extra support available through grants to states.

  • Make “copper plans,” or catastrophic plans, available to consumers of all ages. Today, they are only available to people under 30, and to exchange plan buyers who do not qualify for Affordable Care Act exchange program premium subsidies.

—-Read Iowa’s Individual Health Rescue Proposal, Dissected on ThinkAdvisor.

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