Susan Collins Moves The Goalposts (Again) On Her Health Care Demands

When Sen. Susan Collins (R-ME) first announced she would support the GOP tax bill that killed Obamacare’s individual mandate, she insisted that three separate health care measures to prop up the Affordable Care Act and protect Medicare recipients be passed before she cast her vote. She then amended her demand, saying the bills had to pass before the tax bill came back from the House-Senate conference committee. She then insisted — after voting for the tax bill — that the policies pass by the end of 2017. When it became clear that wasn’t possible in the face of staunch opposition from House conservatives, she expressed confidence they would become law in January.

Now, Collins is moving the goalposts yet again.

In an interview with Inside Health Policy published Thursday, Collins said she hopes the policies she proposed will pass and be implemented before 2019, when the repeal of the individual mandate is expected to shrink the individual insurance market by several million people and drive up premiums by at least 10 percent.

“When the mandate is repealed in 2019, we must have other health care reforms in place in order to prevent further increases in the cost of health insurance,” Collins’ office said in a statement. “Senator Collins believes that averting these price spikes, particularly for low-income families, should be a goal that members of both parties can embrace.”

One of the bills — dubbed Alexander-Murray after its bipartisan Senate authors — would restore government subsidies to insurance companies, known as cost sharing reduction (CSR) payments, that the Trump administration cut off earlier this year. The other would send states $500 million in 2018 to set up a reinsurance or high-risk pool program, and then $5 billion a year for 2019 and 2020.

But it remains in dispute whether the two policies have any hope of passing Congress this year — considering prominent House members have characterized them as “welfare” and a “bailout” for insurance companies — or whether they would actually make in difference in stabilizing the health care market and lowering premiums.

On the first, the ship may have sailed.

Alexander-Murray was drafted before the Trump administration cut off the insurers’ subsidies, a move that surprisingly ended up giving millions of people access to better and cheaper plans than in previous years due to how state insurance officials adjusted their programs in response to President Trump’s decision. Though some middle class, un-subsidized Americans did see painful price hikes, the vast majority of people in the individual market were protected from premium increases by the Affordable Care Act’s subsidy structure. Adding the CSR payments back in now could cause even more disruption in the market.

Even the policy’s original author, Sen. Patty Murray (D-WA), said in late December that it would not come close to mitigating the damage of repealing the individual mandate. “The bipartisan bill I originally agreed on with Chairman Alexander will not make up for this latest round of Republican health care sabotage,” she said. “In fact, there are changes that now need to be made to ensure it meets its intended goals of keeping premiums down and stabilizing markets.”

As for the reinsurance-high-risk pool bill, health care experts have said it may prevent some premium increases, but would do nothing to prevent millions more people from becoming uninsured following the mandate’s repeal. Additionally, having already cast her vote for the tax bill, Collins’ leverage to get these measures past has significantly diminished.