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What Is Happening With the Affordable Care Act?

This week, the Senate will do something it hasn’t done in seven years: hold bipartisan hearings on the future of the Affordable Care Act. Serious and creative ideas are expected to be presented but no real changes are expected. Experts close to the congressional process say that very few reforms have any chance of becoming law before insurers begin selling Obamacare plans for next year.

Congress is looking at a fix that would bring certainty to payments the federal government makes to subsidize plans for low-income Americans. Those payments, which are called cost-sharing reductions and go to the insurers, are outlined in the Affordable Care Act, but there is uncertainty whether the money could be distributed without a clear spending bill from Congress.

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So far, the payments have been made every month but President Trump has repeatedly threatened to stop them. Many health insurers have said their worries about the payments have led them to exit Obamacare markets or charge substantially higher insurance prices next year.

Legislation that assures the subsidies for a year or two could tie the president’s hands and reduce the uncertainty for nervous insurers. But even though some Republican congressional leaders have embraced the idea, it’s not clear whether enough Republicans will end up voting yes.

“The idea of doing it just month-to-month everyone agrees is crazy. Trying to do it year-to-year is better but not much better,” said Washington state insurance commissioner Mike Kreidler (D), who will testify at the Sept. 6 hearing along with other state insurance officials.

“You have to permanently fund them, or fund them so it’s not month-to-month. It definitely needs to be out there for several years. That’s the kind of planning schedule insurers are on. If you’re doing it month-to-month or year-to-year, it becomes tenuous whether they can count on it or not.”

Alexander and other Republicans have said the stabilization bill should also include some health-care reforms, namely through the expansion of Obamacare’s state waivers which experts close to Congress have identified as one of the other areas of possible policy-making: more leeway for states that wish to manage their insurance markets in experimental ways. The Affordable Care Act already had a waiver program, but it established a very high bar for state policy experiments.

Changes to the state waiver standards might change things down the road, but they are unlikely to make any difference next year. That’s because, even with new rules, states would still need to propose new plans and win approval.

Other ideas will be more novel still. A bipartisan group of eight governors put forward a letter to Congress last week outlining a series of policy ideas. Among them: Let Americans with limited Obamacare insurance choices buy coverage through the federal employee health benefit system. Two of its Democratic authors, John Hickenlooper of Colorado and Steve Bullock of Montana, will testify before Congress on Thursday.

As we've done all year, ElderCounsel will continue to follow this topic and keep our membership up-to-date on the ever changing laws. This is one of the many resources offered to members. We cover legal document drafting needs with ElderDocx, a wide variety of premium attorney education, and practical strategies to elevate law practices. Contact us to learn more about membership.

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