The Problem Solvers Caucus, a bipartisan group of 43 House of Representative members, announced Monday that they have agreed on principles for improving Obamacare.
"The Caucus hopes to restore some predictability as insurance companies make decisions about premium prices in 2018," the announcement said.
The caucus is 21 Republicans and 22 Democrats, with another Republican expected to join soon.
They are asking the committees with jurisdiction over taxes, appropriations and health to address the issues. The response from leadership of the House Energy and Commerce Committee's Health Subcommittee was lukewarm.
"The House acted, and we are eager for the Senate to follow suit," a spokeswoman said, referring to the fact that the House on May 4 passed the American Health Care Act. While the bipartisan group does suggest some elements of the AHCA become law—such as sending money to the states for reinsurance— most of the AHCA's changes are not part of the group's approach. She added that Subcommittee Chairman Michael Burgess (R-Texas) doesn't have any plans "at this time" for hearings on the caucus' proposal.
The coalition, led by Reps. Tom Reed (R-N.Y.) and Josh Gottheimer (D-N.J.), is pushing a set of bipartisan solutions after the Senate failed to pass legislation to repeal and replace the Affordable Care Act. While Senate Majority Leader Mitch McConnell has indicated that he's ready to move to other issues, President Donald Trump over the weekend again implored GOP leaders to act, tweeting "if a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!". The House is in recess until September.
Topping the caucus' wish list is securing appropriations for cost-sharing reduction payments, the roughly $7 billion in annual reimbursements insurance companies get for offering low-income customers reduced co-pays and deductibles without those costs being priced into premiums.
House Republicans in 2014 successfully challenged the legality of the payments, arguing that Congress holds the power of the purse, not the executive branch. An appeal has been on hold since the Trump administration took office. So far, the administration has made CSR payments on a month-to-month basis, leading to a fair amount of instability as state regulators and insurers seek to set rates for 2018.
Another proposal is that the federal government send states money for reinsurance and other strategies to reduce premiums.
The caucus also recommends that the employer mandate to provide insurance only apply to companies with 500 employees or more. According to an analysis by Kaiser Family Foundation, 96% of companies with 100 employees or more offer health insurance to full-time employees. The current mandate starts at 50 employees; 89% of companies with 50 to 99 employees offer health insurance, Kaiser estimated. The Problem Solvers group also said the full-time definition should be 40 hours a week rather than 30.
The caucus also asked HHS to revise guidance on Medicaid 1332 waivers, and issue clear guidance on ACA Section 1333. The 1332 waivers have been used by Minnesota and Alaska to establish reinsurance programs since the national reinsurance program ended last year. Section 1333 allows insurers to sell across state lines, if state regulators agree. No states have yet set up an interstate compact.
The caucus also recommends that the medical-device tax, which has been delayed the past two years, be repealed.
All of these spending programs and choices to forgo revenue should have offsets, the caucus said.
The lawmakers say they will meet with constituents and stakeholders in August "to explore additional ways to improve patient choice and responsibility, create positive incentives for providers to lower costs, and enhance state flexibility."
The Heritage Foundation's Robert Moffitt calls ideas like these "further bailouts" and "tinkering around the edges."
"Such feckless remedies are unlikely to provide anything close to permanent relief for enrollees in the individual or small group markets," he said.
