Alexander: GOP May Need to Fund Some of ACA to Keep Market Afloat

A senior Republican said lawmakers may need to fund Affordable Care Act programs that they haven’t given money to in recent years in order to stabilize the individual insurance market, even as the GOP works to repeal and replace the same health care law.

Sen. Lamar Alexander (R-Tenn.), chairman of the Health, Education, Labor and Pensions Committee, told reporters Wednesday that Republicans may need to fund the ACA’s cost-sharing reduction or reinsurance programs, even though they don’t support them, so health insurers continue to sell to individuals.

“If we don’t do something by March or April, people are going to be standing there with a bus ticket and no bus to get on,” Alexander said, meaning consumers might have a subsidy to help buy insurance but no insurers offering plans in their county. “We may not like those things, but we may have to do those things for the next two or three years to make sure people can buy insurance.”

His comments came after health insurers told the panel they need more details about how lawmakers will seek to stabilize the individual insurance market, and soon.

Ideally, insurers need a commitment that they’ll receive money under the ACA that would help them better plan for next year, said Marilyn Tavenner, president of the trade group America’s Health Insurance Plans. Insurers also urged the GOP to take steps that wouldn’t further disrupt the marketplace.

Tavenner; Julie Mix McPeak, commissioner of the Tennessee Department of Commerce and Insurance; and Janet Trautwein, CEO of the National Association of Health Underwriters, said insurers need Congress to act by March on plans for 2018, which could entice companies to remain in the market next year. Insurers have until April or May to submit their 2018 plans for approval by state or federal regulators.

“Strong signals of certainty can help stabilize this market, avoiding even higher cost and fewer choices,” Tavenner said. “We recommend continuing to provide subsidies such as the advanced premium tax credits and cost-sharing reduction payments in their entirety. The absence of this funding would further deteriorate an already unstable market.”

More clarity from Congress is likely this month on the ACA’s cost-sharing reductions. A federal judge last year sided with House Republicans and said the Obama administration had acted unconstitutionally by funding these reductions without a specific appropriation from Congress.

GOP lawmakers are now weighing whether to fund this part of the ACA anyway next year to stabilize the markets while they act to repeal and replace the law. Still, conservatives are loath to be seen continuing parts of a law that they have railed against for years.

Insurers are already starting to plan where they will participate in the individual market in 2018. Lack of certainty on what happens to the ACA may give consumers fewer options. Aetna CEO Mark Bertolini, for example, said this week that the company doesn’t plan to expand into any new markets in 2018.

Tavenner, who led the Centers for Medicare and Medicaid Services under the Obama administration, said cost-sharing or reinsurance payments to insurers were “critical” to avoiding significant stress in the individual market.