Earlier this week, Sen. Lamar Alexander (R-TN) did something few Republicans have dared to do since the election: go into some detail of how he would like to see lawmakers go about transitioning into a replacement for an Affordable Care Act.
His vision, which he outlined in a speech on the Senate floor Tuesday, is earning measured praise from some health care policy experts for at least acknowledging that Republicans may have to keep some aspects of Obamacare alive while they work on an alternative to avoid causing major chaos to the individual market.
“If they don’t want to crash the system this is the only way they can proceed, which is very carefully,” said Timothy Jost, a health law specialist at the Washington and Lee who is supportive of Obamacare. “Not following President-elect Trump in trying to replace it in one hour, but rather by taking time to disassemble it, in a very thoughtful and careful basis.’
In his speech, Alexander proposed holding off on full repeal until an alternative has been offered, in likely a piecemeal fashion. In the meantime, he pitched a set of short-term measures that would keep insurers incentivized to stay in the marketplaces while a replacement could be hashed out. Those measures included maintaining certain subsidies to insurers promised by the Affordable Care Act, as well as a continuation of the Obamacare individual marketplaces, but with the option for consumers to use their tax credits on state-approved plans outside of the exchanges.
“These are standard, reasonable ideas,” said Joseph Antos, a health policy scholar at the right-leaning American Enterprise Institute, “which is a sign we’ve seen, not just from Sen. Alexander, but others in the Senate, especially, that they will go along with a repeal bill but as part of that they want to signal very strongly — either with an actual bill or signal very strongly — what will go in a mainstream replace bill.”
Congressional leaders have promised that in theory replacement measures will come after the law is repealed, but they have offered few details about what proposals are on the table or even the timing to expect them. This has prompted a fair number of Republicans to express their discomfort with repealing Obamacare without a replacement ready. Alexander has taken the next step of elaborating on his ideas for going from the ACA through a transition period and ultimately into a replacement.
“What Senator Alexander suggested leaves the Affordable Care Act entirely intact for some period of time, which goes further than other proposals out there,” Larry Levitt, vice president of the Kaiser Family Foundation, said.
As chair of the Senate Committee on Health, Education Labor and Pensions (HELP), Alexander stands to hold sway over the legislation that repeals Obamacare. The plan, once an initial procedural step passes in the House, is for the relevant House committees to write their own repeal legislation, before the Senate HELP and Finance Committees take their stabs at it.
“I am doing what I think the chairman of the HELP Committee ought to do in the middle of a debate about repealing and replacing Obamacare,” Alexander told reporters the day after his speech. “Obviously, I wouldn’t be making these suggestions if I didn’t think they had a good chance of representing the view of enough Republicans to help us get to 51 votes, but we’re still working on it.”
One of the most noteworthy proposals Alexander offered in the speech was the continuation on what’s known as cost sharing reduction (CSR) payments to insurers. The payments, which subsidize insurers for keeping out of pocket costs down for low income consumers, are among the measures the Affordable Care Act took to blunt the risk insurers face. They have also been decried by GOP lawmakers as “insurer bailouts” and the CSR payments are subject to a lawsuit brought by the House Republicans in 2014. Their fate remains in flux after a federal court ruled against them.
In his floor speech, Alexander proposed that lawmakers approve of a “temporary continuation” of the payments.
“We may have to agree to do some things for a two- to three-year period that we normally wouldn’t do in the long-term to make sure we give people the relief,” Alexander (R-TN) told TPM last month, when asked whether those kinds of measures were on the table.
In his speech, Alexander fashioned these measures not as bail outs, but part of a “rescue” mission.
“Maybe ‘rescue mission’ is the magic language. They have to do it, or it’s going to crash on their watch,” Jost said.
It’s not as clear the impact the other proposals he offered would have on the market, and what they would mean for consumers in the so-called “transition” phase. The effect of letting consumers use their ACA subsidies on non-marketplace plans will depend largely on how closely they resemble the current plans that are in line with the Obama administration’s interpretation of the 10 Essential Health Benefits, mandated by the Affordable Care Act.
“It’s one thing if he’s talking about ACA-compliant policies outside the marketplace,” Levitt said. If consumers were using subsidies on plans that followed basically the same rules, then Levitt predicted that could lead to a “perfectly stable situation.”
However, if Alexander’s vision includes the return of the kinds of plans states allowed before the ACA, such as ones that allow insurers to underwrite based on gender or pre-existing conditions, or plans that are short-term policies, Levitt predicted a situation that would be “very unstable and likely unworkable.”
“That would siphon off healthy people from the marketplace and likely would leave a very unstable insurance market, with premiums increasing and insurers exiting,” Levitt said.
Regardless, the direction appears toward a system where states have more control over what kinds of insurance plans are offered.
“What he is really trying to say is, ‘states should have most of the regulatory [oversight of] insurance markets, they’re closer to the market, they’re much better,’” Antos said.
However, some health policy experts warned of an attempt to pass the buck onto the states if the federal government failed to stabilize the marketplaces after repealing Obamacare.
“The rescue mission is something that [lawmakers] should be cheered on for, but we should watch carefully if they’re going to transfer blame and responsibility to the states,” Jost said.
GOP/TRUMP/DEPLORABLES/STATE OF THE UNION: FUBAR… it’s gonna be get sick, die quick.
Republican subhumans delivering on their promises. What happens when healthcare system collapses because of their whoring? Nothing, the supporters of #PutinsBitch are oblivious to all outside stimulus. The just keep pressing that button and the electrodes keep stimulating their pleasure centers and that’s all that matters. I hope their deaths are slow and extremely unpleasant.
“as well as a continuation of the Obamacare individual marketplaces, but with the option for consumers to use their tax credits on state-approved plans outside of the exchanges.”
Step One…to be “refined” by lifting the state-approved notion and replacing it with the selling of policies across state lines. These policies, both the ones Alexander is proposing and the eventual “national” ones will be a return to the “catastrophic care” policies that cover nothing at all…but have lower premiums.
This will be a key provision for them, especially when the tie it to a mandate…much like how most states require you to buy insurance to drive a car. Go to an emergency room without insurance, and get a court summons for violating the law. This will serve two purposes…it will drive business to insurance companies…and by business I mean people giving them money without them actually have to provide any service…and it will keep people away from the emergency rooms when they don’t have coverage, driving out that particular cost driver.
The part of Alexander’s plan that will be much more difficult to swallow, is the notion of “making insurance companies right” for some interim period until they get their plan in place. Selling your voters that they had to eliminate their subsidies for insurance, thus making them uninsured, in order to pay the very same insurance companies directly for NOT providing insurance will not go over well in 2018.
What we are seeing here is a bit of a panic on the GOPers side. Some of them at least are realizing that Ryan’s drive to repeal immediately is a train that runs out of track as it goes off the cliff, electorally speaking. What they don’t seem to grasp is that Ryan’s drive for an early repeal without a replacement plan, essentially guarantees there can be no replacement plan…not even some bastardized version of Price’s plan…because once they do away with the taxes in the ACA, they have no money to implement any other plan. Oh…and while Ryan likes to talk(right now) about staying away from Medicare…by repealing ACA he will be making Medicare insolvent…so the next order of business, before they can discuss any replacement, will be voucherizing Medicare at deeply discounted rates.
Manufactured crisis…its the only way the understand
Is there actually someone in the Republican Party who sees that simply repealing Obamacare would be a disaster, both for the insured and the insurers? This shows a level of awareness that one does not normally associate with Republican Senators, especially those from Tennessee. Will a calmer voice prevail? Or will the majority of the Republicans continue with their plans to thwart the will of the American people? Experience says the latter, and optimism (the triumph of hope over experience) is in short supply in today’s America.
I called Alexander’s Nashville office yesterday morning. I was flabbergasted at the vote, especially since not even 24 hours earlier, he told the press he would not repeal without replacement.
The staff woman told me that he was working on a replacement and it would keep the pre-existing conditions clause and it would get rid of the employer mandate clause. She also told me to watch a video on his site about his plan- I haven’t watched it, yet.
She told me they had to do this “budget resolution” in order to start on their replacement and that it wasn’t a repeal. I was quite skeptical of this and voiced it. Glad to know he is actually doing something and not just sitting there lying to us, still I am concerned of what Lamar! creates.