The second of four hearings scheduled by U.S. Senator Lamar Alexander from Tennessee and Patty Murray of Washington as Chairman and Democratic Ranking Member, respectively, of the U.S. Senate Committee on Health, Education, Labor and Pensions on the topic of “Stabilizing Premiums and Helping Individuals in the Individual Insurance Market for 2018,” had the same themes from five Governors as the five Insurance Commissioners from the day prior.
In addition to Tennessee Governor Bill Haslam, the other four witnesses were Governors Charlie Baker of Massachusetts, Steve Bullock of Montana, Gary Herbert of Utah and John Hickenlooper of Colorado.
In their opening comments, all five governors echoed the comments of the Insurance Commissioners’ testimony and that of Sen. Alexander to achieve premium stabilization in the individual market for 2018.
Measures the governors and insurance commissioners encouraged Congress to take included continuing the cost sharing reductions (CSRs), seeding state reinsurance programs and streamlining the Affordable Care Act’s (ACA) Section 1332 Waiver process.
CSRs, subsidies that lower out-of-pocket expenses of co-pays and deductibles for individual market participants who purchase a specific subsidized plan sold on the healthcare.gov exchange, are funded on an annual basis. The consensus from committee members and witnesses is that the commitment to that funding should be extended at least two years to provide insurance companies with stability.
Reinsurance, in general, is intended to offset the costs of more costly participants in the individual market healthcare plans, although there are multiple ways to establish such a program. States prefer to take on the management of the program themselves, but need federal funding to seed the program for at least the first year.
Changes to the 1332 waiver process will allow states to customize aspects of the ACA within certain boundaries for their specific needs.
Essentially, the hearings have established that the committee, led by Tennessee’s Sen. Lamar Alexander, has given up on their seven years of promises to repeal Obamacare, as also evidenced by his vote in July against full repeal. To that end, witnesses were asked only to provide their testimony and responses to questions in the context of “tweaking” Obamacare, to stabilize premiums for one year.
There is a feigned sense of urgency, due to insurance providers needing to establish premium rates for calendar 2018 by the end of September, although Congress did take their scheduled August recess.
The governors of eight states, led by John Kasich of Ohio and John Hickenlooper of Colorado, put together a five-page letter dated August 30 to the House and Senate majority and minority leaders with their recommendations, which was attached to Hickenlooper’s testimony at Thursday’s hearing. Predictably, the letter called for the same “tweaks” as outlined in the past two days of hearing testimony.
Rather than discussing that Obamacare is the only federal mandate for purchase of a product or service with ever increasing limited options for the individual marketplace, which may be the underlying cause of under-enrollment, some witnesses and committee members questioned how to force more into participation through programs such as “auto-enroll,” as suggested by Sen. Susan Collins (R-ME).
The third and fourth hearings scheduled for September 12 and 14 will focus on “State Flexibility” and “Health Care Stakeholders,” and can be watched live here.