Amid deep uncertainty about the fate of the cost sharing reduction payments (CSRs) to insurers that subsidize health insurance for the sickest Americans, and with the Trump administration publicly toying with cutting off the payments, Congress may take matters into its own hands.
Sen. Lamar Alexander (R-TN), who chairs the committee that oversees health care policy, is shopping around a proposal to appropriate funding for the CSRs for one year, giving some stability to an insurance market that right now is at the mercy of Trump’s month-to-month whims.
“I hope to get a consensus about how to stabilize the individual market, keep premiums down, keep insurance companies in the individual market so people can buy affordable insurance,” Alexander told reporters Wednesday, saying he hopes to pass such a bill before the end of September, when insurance companies will submit their 2018 rates. “I would expect them to lower their prices as a result of the certainty that Congress is providing.”
If Trump cuts off the payments and Congress does nothing, Alexander warned, insurers will drastically hike premiums and leave certain parts of the country altogether.
“There are a number of issues with the American health care system, but if your house is on fire, you want to put out the fire,” he said.
Though many senators on both sides of the aisle told TPM they support the concept of appropriating the CSR funding, passing a bill will still be an uphill battle. Democrats say one year of payments is not enough, and Republicans are demanding a weakening of health care regulations to go along with any CSR payments.
“We certainly should get some structural change in exchange for that. We can’t just throw money at the problem,” Sen. Ron Johnson (R-WI) told reporters Wednesday.
A few hardline conservative Republicans went even further, agreeing with Trump that the payments should be cut off entirely as a tactic to force a “deal.” But most Republicans as well as Democrats appeared to agree with Alexander that Congress must act to “put out the fire.”
“We will eventually repeal Obamacare and put something better in its place. In the meantime I think it’s very important that we don’t see any Americans get hurt,” Sen. John Kennedy (R-LA), a staunch critic of the Affordable Care Act, told reporters. “I’m not interested in hurting any American and taking away anybody’s health care.”
Sen. Mike Rounds (R-SD) agreed. “Certainly I think having those payments made means there will be less pain inflicted on individuals in the health care market that right now are having a real tough time,” he said.
For their part, Democrats are eager for Congress to take the issue out of Trump’s hands, but say the one-year time frame is inadequate.
“Insurance companies want to know that these payments will be there not just this year, but next year,” Sen. Chris Murphy (D-CT) told reporters Wednesday. “They make long-term decisions when they choose what rates to set and how long to stick around. We should set our sights higher than just fixing this for a year.”
Murphy, who sits on Alexander’s committee, said he’s well aware Republicans will likely demand some “flexibility”—code for deregulation and the rollback of protections—in exchange for appropriating the money, and Democrats are willing to hearing them out.
“There’s a big middle ground between existing law and the Cruz amendment, between the existing minimum health benefits and the total elimination of the minimum health benefits,” he said.
The most important thing, emphasized Sen. Dick Durbin (D-IL), is not to wait to act until Trump blows up the individual market by making good on his threat to cut off the payments.
“Doing nothing is not an option,” he told TPM. “We should not wait on anything. There is too much at stake.”