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By Sara Hansard
A Republican bill repealing the Affordable Care Act isn’t likely to be the legislation that eventually passes, the GOP commissioner who leads state health regulation said March 8.
The American Health Care Act, which two House committees started action on March 8, “ultimately will not be, in my opinion, the proposal that eventually passes, if something passes,” Maryland Insurance Commissioner Al Redmer Jr. told a conference held by America’s Health Insurance Plans. Redmer is chairman of the National Association of Insurance Commissioners’ (NAIC’s) health insurance committee. Both he and Wisconsin Insurance Commissioner Ted Nickel, who is president of the NAIC this year, said selling health insurance across state lines, a proposal in the Republican legislation, doesn’t work well because it is difficult to create health-care provider networks in different areas.
The two insurance commissioners, both Republicans, underscored some of the criticisms that have been aired since House Republicans unveiled their proposal March 6. Both, however, said they welcomed the proposal’s greater reliance on state regulatory authority over insurance. They also said they support high-risk pools to cover people with medical problems, another component of the Republican legislation.
Asked about the proposal to enhance sales of health insurance across state lines, which President Donald Trump called for during his presidential campaign, Redmer said he is “not a big fan of preempting or eliminating our ability in the states to protect our consumers. There are already opportunities for carriers to do business around the country. You just have to abide by the rules of that state, and any environment that would create a race to the bottom of gutted consumer protections is something that I would be concerned about.”
Redmer said the cost of premiums reflect the cost of delivering health care, which varies in different places. “You’re not going to buy an insurance policy in rural Iowa and live in Maryland and have your health care delivered at Johns Hopkins University without having the same cost of delivering that care,” he said.
But both Nickel and Redmer favored providing more funding for states that want to go back to state high-risk pools for people with medical problems, which existed in 35 states before the primary provisions of the ACA took effect in 2014. The new bill includes funding that states could use to set up the high-risk pools.
“We had a well-functioning high-risk pool in Wisconsin prior to the ACA, which we completely had to dismantle given the fact that we had exchanges and subsidies available,” Nickel said. About 90 percent of consumers in Wisconsin had access to affordable health care before the ACA, and the share has grown “due to a lot of the decisions we made around the ACA,” he said.
Under Wisconsin’s former high-risk pool program, people who were rejected for coverage were eligible for subsidized policies, and the cost of the subsidies was shared by consumers who bought commercial plans, insurers and providers, Nickel said. The plans could be used anywhere in the state without network requirements, and enrollees “had access to affordable health care,” which many liked, he said.
“We’re willing to go back to that model,” Nickel said. “It’s a viable option.”
Redmer agreed. “We had a very successful, well-functioning high-risk pool that was very [competitively] priced to the underwritten individual as well as the small-group market,” he said.
At AHIP’s luncheon, former House Speaker Newt Gingrich (R) said the House is constrained from offering legislation to repeal and replace the ACA because of the Senate’s filibuster rules.
The bill is being written as reconciliation legislation, which needs only a simple majority to pass and which can only include measures that narrowly affect expenditures, Gingrich said. “So you end up with a bill that’s in some ways a little bit deformed by the legislative requirements,” he said.
Conservative segments of the Republican Party, such as the Freedom Caucus, are hostile to the Republican bills because they contain too many entitlements.
“I suspect that there’s enough conservative opposition, they’re going to have to do something to accommodate parts of it,” Gingrich said. But in the Senate, there could be as many as 10 Republicans, both moderates and conservatives, who are currently not supportive of the legislation, he said. There are only 52 Republicans in the Senate, and Democrats are not likely to support the legislation, he said.
Still, “It’s very unlikely that a president as willful, as intelligent and as energetic as Trump is going to lose his first big bill,” Gingrich said. “I will stipulate right now, something will be signed into law. I don’t have a clue what it will look like. I actually don’t think they do either because they’ve got to wait and see how the pressure cooker works.”
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The American Health Care Act is at https://housegop.leadpages.co/healthcare/.
Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.
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