Should the bipartisan health bill pass?

• Appropriates money to fund the cost-sharing reductions (CSRs) that lower deductibles and other out-of-pocket spending for people in the exchanges. Not funding these is estimated to have added ~20% to premium increases for 2018, so this is largely an attempt to undo some of that damage.
• Requires insurers to issue rebates (to consumers and the federal government) of the portion of the artificially-high 2018 premiums that are attributable to the CSRs not being funded.
• Expands access to "copper" plans: catastrophic plans that are less generous (i.e., have higher cost-sharing, like deductibles) than the bronze plans that normally constitute the barest-bones coverage available. Currently only people under 30 and folks who otherwise don't have access to affordable coverage are allowed to buy copper plans; under this bill, any shopper in the individual market could buy one.
• Speeds up the approval process for the ACA's State Innovation Waivers (waivers of the law that allow states to use pass-through money from the ACA to modify the program or try alternatives), with an eye toward encouraging states to set up reinsurance or other risk mitigation programs.
• Restores funding for enrollment outreach that had been cut by the Trump administration.
• Requires HHS to issue regulations implementing the ACA's interstate health compact option (allowing interstate insurance sales).

Greenbeard said:

As most folks have probably heard, the Senate has come up with a bipartisan bill (Alexander-Murray) to try and correct some of the artificially-induced issues that exchanges are experiencing right not. It appears to have a filibuster-proof majority--all 48 Democrats + 12 GOP co-sponsors--yet Trump and Ryan have come out in opposition, while McConnell won't allow a vote until Trump is onboard.

The legislation itself is pretty simple. It:

• Appropriates money to fund the cost-sharing reductions (CSRs) that lower deductibles and other out-of-pocket spending for people in the exchanges. Not funding these is estimated to have added ~20% to premium increases for 2018, so this is largely an attempt to undo some of that damage.
• Requires insurers to issue rebates (to consumers and the federal government) of the portion of the artificially-high 2018 premiums that are attributable to the CSRs not being funded.
• Expands access to "copper" plans: catastrophic plans that are less generous (i.e., have higher cost-sharing, like deductibles) than the bronze plans that normally constitute the barest-bones coverage available. Currently only people under 30 and folks who otherwise don't have access to affordable coverage are allowed to buy copper plans; under this bill, any shopper in the individual market could buy one.
• Speeds up the approval process for the ACA's State Innovation Waivers (waivers of the law that allow states to use pass-through money from the ACA to modify the program or try alternatives), with an eye toward encouraging states to set up reinsurance or other risk mitigation programs.
• Restores funding for enrollment outreach that had been cut by the Trump administration.
• Requires HHS to issue regulations implementing the ACA's interstate health compact option (allowing interstate insurance sales).

The verdict from the CBO is that the bill will reduce the deficit by $3.8 billion and keep premiums in 2019 lower than they'd be in the absence of the CSRs.

So: should Congress pass this and should the president sign it? Should this bill become law?

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1. The cake is already baked on 2018 premiums. A lot of them are jumping big time because the CSRs weren't funded, but there's no reversing that now. Trying to rebate back the excess part of the premium is convoluted. If this bill had passed eight months ago that would be one thing (it would've prevented all this and 2018 would've generally seen no-to-low premium increases), but we might as well spend our energy working on what to do for 2019 now, since premiums for 2019 will be set in the spring/early summer of next year.
2. Insurers have to lower deductibles, etc for eligible enrollees regardless of whether HHS fulfills its part of the bargain and reimburses them for it. So low-income folks will still enjoy the benefits of the CSRs regardless of whether this bill passes.
3. Because states saw this coming, most of them took actions that to some extent actually allow them to take advantage of the situation. As a result, the perverse unintended consequence of all this is that it achieves something liberals have wanted from the start: an increase in the generosity of the premium tax credits. In any state below in green ("silver switch") or yellow ("silver load")--and perhaps in some cases in the blue states ("mixed")--lots of areas are going to see situations where anyone getting a premium tax credit is going to see the price of bronze and gold plans fall, even as the price of silver plans stays the same or decreases for them. In other words, coverage is actually going to get a lot more affordable for lots and lots of (subsidized) people. And the green states have set things up in a way that mitigates the impact on un-subsidized people at the same time.

An Unintended Side Effect Of Trump’s Move To Cut Off Insurer Subsidies: Free Health Coverage

In nearly all of the 2,722 counties included in a recent report, some consumers will be able to obtain free health insurance because they qualify for larger federal premium subsidies that cover the full cost of a plan now that President Donald Trump has stopped cost-sharing payments to insurers. In other health law news: what the marketplaces are going to be like for consumers this year; navigator funding; what Americans want the path forward to be; and more.

The Wall Street Journal: More ACA Plans To Come With No Premiums In 2018
Insurers selling Affordable Care Act plans have a compelling new pitch: free health insurance. When sales of plans on the law’s exchanges begin Nov. 1, a growing number of consumers around the country will be able to get coverage for 2018 without paying any monthly premium, according to health insurers and an analysis of newly available federal data. (Wilde Mathews and Weaver, 10/27)

The Hill: Trump's ObamaCare Move May Bolster Law
President Trump’s decision to cancel key ObamaCare payments could be backfiring. Trump has claimed the health law is “imploding,” and earlier this month he took an action seemingly aimed at that goal: cutting off key payments to insurers known as cost-sharing reductions. (Sullivan, 10/27)

The Washington Post: What It’s Like To Look For Health Insurance Now That Trump Has Tried To Undermine Obamacare
Cindy Purvance of Park City, Utah, was incensed when she received a letter in the mail alerting her that her family’s health insurance premium would skyrocket to $1,300 a month next year — a $500 increase. Purvance vented on social media, called her insurance company and eventually consulted with an expert who helps people sign up for health plans. She learned something counterintuitive: She would probably see a smaller increase if she bought the same kind of plan she currently has — but off the Affordable Care Act exchange. (Johnson, 10/26)

[...]

KCUR: Good News And Bad News For Missourians Buying Marketplace Health Plans For 2018
There’s some good news and some bad news for Missourians purchasing marketplace healthcare plans under the Affordable Care Act. The good news: Those eligible for premium subsidies will see no increase in their premiums. In fact, a 40-year-old non-smoker earning $30,000 a year will see a 2.7 percent reduction of his or her premiums to $201 a month. The bad news: Those not eligible for subsidies will see premium increases ranging from 12 percent to 50 percent for the benchmark silver plan. (Margolies, 10/26)

Cleveland Plain Dealer: Surprise: Obamacare Will Cost Some People Less Under Trump, Not More
Despite the sharp rise of Obamacare premiums in 2018, a number of people in Ohio and elsewhere will wind up paying less, not more, a cleveland.com review of coming premiums shows. Some people can even get richer health coverage: a gold-level plan for less than they paid for a silver plan in 2017. (Koff, 10/26)

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Greenbeard said:

The verdict from the CBO[/URL] is that the bill will reduce the deficit by $3.8 billion and keep premiums in 2019 lower than they'd be in the absence of the CSRs.

So: should Congress pass this and should the president sign it? Should this bill become law?

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MaggieD said:

I voted yes. Bipartisan support is the only way to fix this mess. If it doesn’t fix it? Both sides suffer.

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