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By Alex Ruoff
House Republicans’ failure to repeal the Affordable Care Act is giving rise to hopes that lawmakers will find a bipartisan way to improve insurance markets and Medicaid programs, representatives of two centrist think tanks told Bloomberg BNA recently.
Health-care issues have grown increasingly partisan as Republicans work to repeal Democrats’ signature health achievement, the ACA, Dave Kendall, a senior fellow for health policy at the Washington-based Third Way, told Bloomberg BNA April 10. But, as Republicans remain at an impasse over how to repeal the law, health policy advisers from Third Way and the Bipartisan Policy Center are pushing lawmakers toward policies where conservatives and liberals agree, with an eye toward reforming rather than repealing the ACA.
The success of this effort will require the stalemate in the House over a repeal bill to continue through the summer and for the White House to turn away from its commitment to undermining the ACA, Kendall said. Only a few weeks ago, neither seemed possible, he said.
“There’s an opportunity to get away from the campaign rhetoric and find answers,” G. William Hoagland, senior vice president for the centrist think tank the Bipartisan Policy Center, told Bloomberg BNA. “We need to talk about improving health care in this country.”
Hoagland, a longtime Republican Senate staffer, wants the GOP to stop talking about repealing the ACA and start talking about fixing insurance markets.
The Bipartisan Policy Center has assembled a team of health policy experts, including Andy Slavitt, who served as acting administrator of the Centers for Medicare & Medicaid Services under President Barack Obama, and Avik Roy, a prominent conservative policy analyst, to come up with bipartisan solutions to pressing health issues, such as insurers leaving some markets.
Third Way and the BPC are reaching out to Senate Republicans to persuade them to work with Democrats to encourage more insurers to participate in the individual health insurance markets where few companies offer coverage, and reduce health-care costs for health-care providers and the government. Most centrists see little opportunity for bipartisan health legislation to come out of the House, where House Speaker Paul Ryan (R-Wis.) has vowed to repeal the ACA and has showed little interest in reaching out to Democrats.
Insurers and policy analysts are watching the Department of Health and Human Services for signs that the Trump administration will abandon efforts to undermine the ACA and focus on encouraging insurers to participate in the individual health markets, Kendall said.
Trump moved quickly when he took office to position the HHS for a post-ACA repeal world by ordering federal agencies to “ease the burden” of complying with the health law. The Internal Revenue Service responded by allowing Americans to file tax returns without indicating if they had insurance coverage, effectively undermining the ACA’s individual mandate.
With the ACA in place for the foreseeable future, Kendall said, many want Trump to reverse this decision and enforce the individual mandate.
Additionally, policy analysts are eagerly awaiting release of a federal rule to help stabilize the insurance market. The rule would give the Trump administration the opportunity to signal a willingness to live with the ACA, Kendall said.
“If they present it as a way to help ensure people can get coverage for the next year and half, not something they have to do until the ACA is repealed, then it would be a huge success in the short term,” he said.
The rule was proposed in February, before Republicans’ repeal efforts stalled, and focused on discouraging people from purchasing insurance coverage only when they’re sick, and on changing network adequacy rules.
When it released the proposal, the CMS said it would amend standards relating to special enrollment periods, guaranteed availability and the timing of the annual open enrollment period in the individual market for the 2018 plan year.
Any hope of bipartisan legislation lies largely in the Senate, which is less fractious than the House, Hoagland said. Senators such as Lamar Alexander (R-Tenn.), Susan Collins (R-Maine), Lindsey Graham (R-S.C.) and Lisa Murkowski (R-Alaska) have signaled a willingness to work with Democrats on major health policy issues.
The Senate is also more focused on responding to the problems of the health industry than the House, where many members are laser-focused on passing any legislation they can call a repeal of the ACA, he said.
“I wish the campaigns hadn’t been ‘repeal, repeal, repeal’ for so long,” Hoagland said. “Now, it’s time to get away from that.”
Several senators have already pushed for small repairs to support the individual market. Alexander and Sen. Bob Corker (R-Tenn.) introduced a bill in March to exempt Americans who live in areas where no insurer offers individual health plans from the ACA’s requirement to have insurance.
However, Rep. Charlie Dent (R-Pa.), the leader of the moderate House Republican Tuesday Group, has repeatedly called for abandoning the House’s repeal bill and finding a way to garner Democrats’ support for health legislation. He and Ohio Gov. John Kasich (R) have started reaching out to freshmen Democrats to talk about possible legislation.
Dent was a major figure in the House’s effort to pass an ACA repeal bill—and its downfall. He pushed for temporarily keeping federal funds for states that expanded their Medicaid programs under the ACA and for refundable tax credits to help poor Americans purchase insurance.
The GOP’s recent embrace of subsidies for insurers that cover people with expensive medical conditions could be a sign that Republicans can sign onto legislative fixes that are palatable to Democrats, if uncoupled from a repeal bill, Kendall said.
Called the Federal Invisible Risk Sharing Program, the Republican proposal would give health insurers $15 billion over nine years to subsidize the care of high-cost patients as part of House Republicans’ ACA repeal bill. It’s similar, though less generous, than the ACA’s three-year reinsurance program, which gave insurers $7.9 billion for 2014 and $7.8 billion for 2015, according to data from the Kaiser Family Foundation, and is intended to pay out $4 billion for 2016 ( 66 HCDR, 4/7/17 ).
Rep. Jim McGovern (D-Mass.) said April 6 that liberals would support such a move separate from repeal. However, he said Republicans have largely discussed their health bill behind closed doors, without any input from Democrats, souring relations between members of the two parties.
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