Yesterday, we got wind of a bipartisan bill to “fix” the Affordable Care Act, but the unfortunate fact of the matter was that the plan was drafted by Lamar Alexander and Patty Murray, easily two of the most unimpressive legislators in America today.
Last night, the news website Axios posted a link to the full text of the bill, and in reading through it, one gets the sense that it really doesn’t do anything at all. Here’s Axios’s recap:
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Revised waiver language requires states to “provide coverage and cost sharing protections against excessive out-of-pocket spending that are of comparable affordability, including for low-income people, people with serious health needs, and other vulnerable populations.”
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State insurance regulators must submit a certification to the Department of Health and Human Services that the state will make sure plans receiving cost sharing reduction subsidies in 2018 pass those benefits on to enrollees or the federal government, and a plan for doing so. This is intended to prevent insurers that charged higher premiums in 2018 in anticipation of not receiving the payments don’t just keep the payments once they’re appropriated.
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Requires HHS to release guidance on model state plans that meet waiver approval requirements. This could include, for example, a state plan to create a reinsurance program or invisible high risk pool.
The first two bullet points are the most important – they essentially explain that Congress wants to undo what Trump did by ending government subsidies of insurance agencies (an effort that was meant to keep costs low). Now, to be fair, this is a legal thing that Congress can do. A court simply ruled the administration could not do it. If it’s done by Congress, then it’s fine.
Well, legally anyway. Fact is, it’s not a good idea. The insurance game is run by big companies and they are simply getting rich off the government subsidies. In reality, large swaths of American taxpayers who are forced into buying Obamacare-compliant plans are not really seeing those savings.
The third bullet point is the interesting point and, I think, the most conser-… well, maybe not conservative, but certainly the most Republican idea to come out of this bill.
There are a number of hoops that states have to jump through in order to be granted a waiver from Obamacare’s massive regulatory structure. A few states have managed to get those waivers, but as more exchanges have collapsed, more states have realized that this is probably problematic and you will probably see more applications in the near future. What this bill seems to want to do is force the Department of Health and Human Services to respond to waiver applications faster, and with easier criteria.
In terms of federalism, this is a pretty “OK” thing for the bill to do. It allows the states more freedom to work on their own stuff… to a point, at least.
However, that is the only notable, positive change for Republican voters to cling to. The rest of the bill doesn’t really solve a whole lot. We’re focused entirely on the subsidies angle and the state regulation angle without realizing that it is the regulations on people and insurance companies that have been doing the most harm.
And doing no harm is a very important part of health care, is it not?