Initial GOP Efforts On Obamacare Transition Focus On Insurer Requests


Judging by the first round of legislation and reported regulations being mulled by Republicans, GOP lawmakers intend to focus on meeting requests by insurers to keep the individual market stable as they move forward with repealing the Affordable Care Act.

Last week, the House Energy and Commerce Committee’s subcommittee on health held hearings on four pieces of legislation, three of which involving tweaks to Obamacare insurers have long recommended. (The fourth bill was a GOP promise to protect the coverage of those with pre-existing conditions, though the mechanism to do so was unclear). Meanwhile, the Health and Human Services Department under President Trump is reportedly weighing regulatory changes to Obamacare that would achieve similar goals.

One House bill would extend the ratio for determining how much more insurers can charge older consumers compared to younger consumers. The current ratio under the ACA is 3-to-1; the House bill would change the ratio, known as the age band, to 5-to-1, making premiums cheaper for younger people and more expensive for the elderly, who are more costly for insurers to cover.

Another bill would require consumers seeking to use special enrollment periods to provide documentation that they qualify, and the third piece of legislation would shorten the grace period that consumers have if the don’t pay their premiums before coverage is dropped. The bills are in line with proposals previously pushed by insurers under the Obama administration.

According to reports by Huffington Post and Politico, the HHS is also perusing an extension of the age band, from three-to-one, to 3.49-to-one (the legality of which is questionable). The administration is considering changes to special enrollment rules and grace period standards, as well as proposals to shorten open enrollment and to give insurers more flexibility in charging out-of-pocket costs in their silver plans, Politico reported based on administration documents,

Softening insurance regulation is not exactly a risky move for GOP lawmakers to take in their nascent steps towards replacing Obamacare. Decreasing the federal government’s role in regulations is a common refrain among GOP lawmakers who have otherwise been vague on what their Obamacare replacement will look like.

However, the recent moves are also a tacit admission that some Republicans see it in their interest to attempt to keep the ACA’s individual marketplaces on life support in the short term while they build consensus around an alternative. Marilyn Tavenner, the CEO of insurer trade group America’s Health Insurance Plans (AHIP), urged them to do as such in Senate testimony last week that cheered some of proposals being offered by Republicans. Other key lawmakers, like Senate HELP Committee Chair Lamar Alexander (R-TN), have espoused rhetoric advocating for a “repair” of the current health care system, while the underlying law is dismantled.