Congress returns from its summer recess amid hopeful signs that moderates in the Senate will craft bipartisan legislation to bolster the individual insurance markets created by the Affordable Care Act.
Those markets are doing far better than advertised. All of the nation's 3,142 counties have a private insurer selling individual plans next year.
And while competition is limited to one insurer in about 47% of counties, mostly in the Deep South, Great Plains and Southwestern states, it affects just 21% of last year's 12.2 million enrollees since many of those areas are sparsely populated.
However, individual premiums will spike by another 20% on average next year unless Congress and the White House fund the cost-sharing subsidies contained in the ACA. A House suit challenging the subsidies' lack of congressional authorization, which won in a lower court, is temporarily on hold.
Those subsidies are crucial to the 7 million people with ACA plans who earn between 100% and 250% of poverty, which is $13,670 for an individual and $27,950 for a family of four in 2017. While their premiums are heavily subsidized, these lower-income Americans can't afford to use their insurance when co-pays and deductibles are high.
The Senate Health, Education, Labor and Pensions Committee, chaired by Sen. Lamar Alexander (R-Tenn.), will hold two hearings in early September. He and ranking member Sen. Patty Murray (D-Wash.) say their goal is to hammer out a limited fix that can pass the House and go to President Donald Trump for signing.
If the panel listens to the testimony that will be offered by state insurance commissioners and the nation's governors, the legislation will include a one- or two-year authorization of the cost-sharing subsidies. The White House has been funding those subsidies on a month-to-month basis.
The commissioners also called for a sizable reinsurance fund to offset the risk of enrolling high-risk patients-the people with serious pre-existing conditions that both political parties and the president promised to protect. In a letter signed by the insurance commissioners from four states, each led by a Republican governor (Maine, South Carolina, Tennessee and Wisconsin), the National Association of Insurance Commissioners said such a fund would require $15 billion to cover its costs through the end of 2019.
In an effort to win more conservative votes, the legislation will also give states greater flexibility to craft their own rules for the exchanges and, perhaps, Medicaid expansion. How far they go in allowing waivers that limit benefits or expand sign-up restrictions and work requirements may determine the bill's fate, since the farther the majority party goes in the direction of "repeal and replace," the more likely it becomes moderate Democrats will bolt and let the bill suffer the same fate as the Senate repeal bill that died in late July.
There's no doubt where the healthcare industry and the nation's employers stand. In early August, a joint statement supporting cost-sharing authorization was signed by America's Health Insurance Plans, the American Hospital Association, the American Medical Association, the Blue Cross and Blue Shield Association, the Federation of American Hospitals and the U.S. Chamber of Commerce.
The president inadvertently helped build support for this bipartisan approach with his latest attacks on Senate Majority Leader Mitch McConnell (R-Ky.) and other mainstream Republicans. They include both senators from Arizona, where the president traveled this week for a campaign-style rally where he once again declared "Obamacare is a disaster."
Unfortunately, his views were echoed by House Speaker Paul Ryan (R-Wis.) this week during his CNN Town Hall meeting. Ryan continues to claim, contrary to evidence, that "Obamacare is collapsing … under its own weight."
Both men have the power to turn that into a self-fulfilling prophecy. Here's hoping that after this divisive summer, they use that power more wisely and help put the exchanges on more solid footing.