Top Senate Republicans are turning their focus to quickly moving bipartisan legislation to stabilize the individual insurance market after last week’s votes on GOP proposals to overhaul the Affordable Care Act (ACA) fell short. In the House too, a bipartisan group of lawmakers are considering targeted fixes to the law, and proposals in play would fund the ACA’s cost-sharing reduction subsidies (CSRs), give states more freedom to pursue their own reforms, and scale back the employer play-or-pay mandate.
While President Trump and several conservative senators haven't given up on full repeal of the ACA, these bipartisan efforts are set to intensify, especially if the president follows through on his threat to shut off funding for the CSRs. The subsidies amount to about $7 billion that reduce premiums for the approximately 7 million Americans who buy exchange-based coverage, and there is broad concern among policymakers and insurers that ending the payments would severely disrupt the market.
Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, R-TN, plans to team with ranking Democrat Patty Murray of Washington to hold hearings in early September with an eye to finding areas of bipartisan agreement and passing legislation before the end of the month. The immediate need to address CSR payments will top the agenda, but many lawmakers will push for a broader discussion of the drivers of health costs.
In the House, the bipartisan “Problem Solvers Caucus” has offered a proposal to bring CSR payments under the congressional appropriations process and make that funding mandatory. The group is also calling for new funds to help states stabilize their insurance markets and give them more leeway under ACA Section 1332 waivers to pursue their own reforms. In addition, they want to trim the employer mandate to cover only firms with more than 500 employees and change the definition of a full-time employee from 30 hours to 40 hours per week.
The timing and content of legislation that could become law is unclear, however. It remains to be seen what qualifies as common ground between the parties beyond funding the CSRs, and lawmakers’ September to-do list is crammed with other urgent priorities including increasing the debt ceiling, fiscal 2018 spending bills, and tax reform. House members have returned to their districts for the August recess, and the Senate officially is set to follow next week.