Work Toward Bipartisan Fix for Health Markets Begins in Senate

The chairman of the Senate health committee said Wednesday that he hoped the panel would reach a consensus by the end of next week on a small, bipartisan bill to stabilize health insurance markets and prevent prices from skyrocketing next year under the Affordable Care Act.

“The blame will be on every one of us, and deservedly so,” if senators fail to reach agreement, said the chairman, Senator Lamar Alexander, Republican of Tennessee.

Mr. Alexander laid out elements of a possible compromise at a hearing on Wednesday: Republicans would agree to continued payment of subsidies to insurance companies to compensate them for reducing deductibles and other out-of-pocket costs for low-income people. Democrats would agree to give states freedom to relax some insurance requirements in the Affordable Care Act.

“To get a result,” Mr. Alexander said, “Democrats will have to agree to something — more flexibility for states — that some may be reluctant to support. And Republicans will have to agree to something, additional funding through the Affordable Care Act, that some may be reluctant to support. That is called a compromise.”

The senior Democrat on the panel, Senator Patty Murray of Washington, said: “Threading this needle won’t be easy. But I do believe an agreement that protects patients and families from higher costs and uncertainty, and maintains the guardrails in our current health care system, is possible.”

The seven-year Republican push to repeal the Affordable Care Act appeared to reach a dead end this summer when multiple versions of repeal legislation failed to gain even a simple majority in the Senate. Lawmakers in both parties said Congress would have to get back to a more orderly approach to making health care policy, and Wednesday’s hearing was a start.

The tone was cordial, a sharp departure from seven years of partisan conflict. However, senators expressed different opinions on how long the subsidy payments should be guaranteed, and whether states should be able to allow the sale of insurance policies that did not provide all the benefits required by the 2010 law.

Insurance commissioners from four states — Alaska, Oklahoma, Tennessee and Washington — and the former insurance commissioner of Pennsylvania told the committee that Congress must immediately provide money for the “cost-sharing” subsidies that enable insurers to reduce out-of-pocket costs for low-income people.

“This issue is not an insurer bailout,” Julie Mix McPeak, the Tennessee insurance commissioner, testified, rebutting an argument made by President Trump and some Senate Republicans. The cost-sharing payments ensure that “some of our most vulnerable consumers receive assistance for co-pays and deductibles,” and they have the effect of reducing proposed increases in premiums, she said.

“We are rapidly approaching a Sept. 20 deadline for states and the Centers for Medicare and Medicaid Services to make final determinations on 2018 rate filings,” said Ms. McPeak, who is the president-elect of the National Association of Insurance Commissioners.

Mr. Trump has repeatedly threatened to stop the cost-sharing payments. A federal judge ruled last year that the payments were being made illegally because Congress had not explicitly provided money for them.

Mike Kreidler, the state insurance commissioner in Washington, told senators on Wednesday, “You must take bold action now to shore up these markets.” He said Congress should guarantee payment of the subsidies at least through 2019.

Mr. Kreidler and several other commissioners urged Congress to establish a backstop for insurers under which the government would help pay the largest claims. More insurers would participate in the market if they knew the government would provide such a backstop, known as reinsurance, the state officials said.

The Alaska insurance director, Lori Wing-Heier, urged Congress to continue support for insurance counselors, whose financing has been sharply reduced by the Trump administration. The counselors, known as navigators, help people sign up for insurance, thus reducing the number of people who are uninsured, and their assistance is vital in rural areas of Alaska where insurance brokers are not always available, she said.

The cuts planned by the Trump administration “will be devastating to our population,” Ms. Wing-Heier said.

A subcommittee of the Senate Appropriations Committee on Wednesday approved a bill that would provide funds for the navigator program and other outreach and enrollment activities. The bill had bipartisan support, and it was significant because the annual open enrollment period, when people sign up for insurance, starts in eight weeks, on Nov. 1.

The bill would not prevent Mr. Trump from making the cuts he wants to make. But it does show a substantial gap between Congress and the president.

The former Pennsylvania insurance commissioner, Teresa D. Miller, said insurers in her state were seeking rate increases that average 8.8 percent for 2018. But, she said, the increases would average 36 percent if the Trump administration does not pay cost-sharing subsidies and does not enforce a provision of the Affordable Care Act that requires most Americans to have insurance.

The Affordable Care Act allows federal officials to grant waivers from some of the law’s requirements, to clear the way for innovative state health insurance programs. The current waiver process is “very cumbersome,” Ms. Miller said. “The more we could streamline that process, the better it would be.”

But, she said, it is important to preserve the “guardrails” that protect consumers. The federal law stipulates that state programs must provide coverage that is at least as affordable as that available under the Affordable Care Act, and must cover “at least a comparable number” of people.

John D. Doak, the Oklahoma insurance commissioner, said the problems in his state began years before Mr. Trump took office.

“We have seen a reduction in competition down to only one carrier on the marketplace, drastic rate increases, constricting networks, higher deductibles and market instability,” Mr. Doak said. “These problems were not caused by uncertainty about cost-sharing reduction payments.”

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