Congress holds first hearing on health care since failure to repeal ACA

WASHINGTON, DC - JANUARY 17: Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R) delivers opening remarks as ranking member Sen. Patty Murray (D-WA) 

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State health insurance commissioners urged lawmakers to pass a bipartisan bill to help stabilize the health insurance market at the Senate's first health care hearing, following its failure to repeal and replace the Affordable Care Act in July.

Sen. Lamar Alexander, R-Tennessee, chairman of the Senate Health, Education, Labor & Pensions (HELP) Committee said Congress needs to take "one small step on a big issue that's been locked in a partisan stalemate for 7 years."

Currently, 18 million Americans who do not get their health coverage from their employers buy their insurance on the individual marketplace. These individuals are the ones most directly impacted by rising premium costs.

Mark Kreidler, Washington state's insurance commissioner, told lawmakers the next two weeks will be "particularly telling" because insurers will be making their final decisions about whether or not they'll participate in the marketplace. Insurance companies face a September 20 deadline for final determination of their insurance rate filings.

But perhaps one of the major sticking points to achieving a more stable market, according to the commissioners at Wednesday's hearing -- representing Alaska, Oklahoma, Washington, Tennessee and Pennsylvania -- is guaranteeing funding for cost-sharing payments that would continue until 2019.  

Cost-sharing reductions, or CSR's, are payments the government issues to insurance companies in order to lower deductibles and out-of-pocket costs.

Should those payments be discontinued, Sen. Patty Murray of Washington said, "premiums could be an average of 20 percent higher for next year for popular plans." She added, "Combined with more uncertainty on the markets and fewer options, that's unacceptable and it is avoidable."

All five commissioners at Wednesday's congressional hearing agreed that permanently funding CSR's through 2019 would help address growing uncertainty among health insurance providers, and help with co-pays and deductibles for many low income Americans.

Mr. Trump has previously threatened to discontinue those payments -- calling them "bailouts for insurance companies" -- in favor of letting the current health care law "implode." Teresa Miller, Pennsylvania's state insurance commissioner, said that "the notion that health care is imploding is just false," but failing to follow through on appropriate funding would directly impact her state.

"The individual market is not collapsing, insurers are seeing improved experience with the market, but stability is on fragile ground surrounding this uncertainty, said Miller. She added, "CSR's have a significant impact on these rates and failing to provide payments will hurt Pennsylvanians."

Aside from CSR funding, the commissioners also unanimously agreed on the need for permanent reinsurance pools to provide further stabilization to the marketplace.

These reinsurance programs help insurers pay for high-cost patients whose treatments can sometimes run millions per year or even per month, but are set to expire later this year, forcing insurers to raise premiums to cover their eventual absence. 

"Creating a federal reinsurance program shows commitment to stabilizing market and another way of reassuring the insurance market and carriers, said Kreidler.  "It doesn't help them financially but it gives them predictability and helps to hold down rates," he added.

While lawmakers are scheduled to continue hearing from members of the health insurance community for the next two weeks, Alexander said providing an open forum for reaching consensus on stabilizing the market and then passing a "small, bipartisan and balanced stabilization bill" are the main goals for Congress as they face an already packed September agenda.

"We can do it here, our goal is a small step but so many Americans will be hurt if we fail, and the blame will be on every one of us if we don't act," added Alexander.