Yesterday afternoon it was announced that Senator Murray and Senator Alexander had reached a bipartisan agreement to provide funding for cost-sharing reduction subsidies and make other minor changes to how the ACA is currently being administered.
This is how the Senate is supposed to work, two sides meet and hash out a compromise. However, questions remain as to if the compromise will be fully accepted (more on that below).
After reviewing the bill, my bottom line is that this is a good deal for supporters of the ACA. It represents some compromises, but to me, the benefits far outweigh my concerns.
Summary of the bill (being circulated by Andy Slavitt):
If you’re interested, here is the full text of the bill.
As mentioned above, as of this morning, acceptance of this compromise by all parties is far from assured. While passage in the Senate is the easier lift, Senator McConnell (as of this writing) has not yet committed to bringing it to a vote.
Prospects in the House are even more questionable, as some conservative Republicans have already come out against the bill.
There are suggestions that the compromise may be part of the next funding bill for the Federal Government (needed by December 8) but those are just rumors at this point.
Finally, the President has been ambiguous in his reaction, while praising the compromise in an afternoon news conference, in the evening he made the following remarks:
It’s also worth remembering that we thought there was a deal to reauthorize CHIP, but we’re still waiting on that to be introduced in both chambers as well as waiting on Community Health Center funding.
So, as of this morning, while I would vote for this bill, it’s unclear if enough of our representatives would do so, or if they will even have the chance to do so.
But hope springs eternal, so let's review a few things about the specifics of the compromise:
- The copper/catastrophic plan is just another option – they will be part of same risk pool as other plans so do not present an adverse selection risk. At the end of the day, due to limits of out-of-pocket max, the plans are not that different than Bronze plans
- This is not a “bailout” – these payments are about providing insurance companies funding for the benefits (cost-sharing subsidies) they are legally obligated to provide
- It is unclear (and to me doubtful) that this will impact rates currently set for 2018. To do so the bill would have to move much more quickly than expected and there would need to be a delay in the start of open enrollment. That said, there will be a mechanism so that insurers are not paid twice for the cost-sharing subsidies
- There is funding in the bill to support enrollment. The money would be sent to each state, and for states that did not want to spend the money (good morning Maine) there are provisions for the Feds to allocate the money within the state so that it would still be utilized
We can expect to hear a lot more in the next few days about if and how this compromise moves forward.
In the meantime, remember that open-enrollment starts on November 1 and if you purchase individual coverage it is urgent that you comparison-shop, given the current state of the market. This morning’s New York Times has a good rundown of the state of things absent passage of Murray-Alexander: Trump’s Attack on Insurer ‘Gravy Train’ Could Actually Help a Lot of Consumers.
As always, thanks for reading and stay tuned.
