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Affordable Care Act

Today’s Scorecard on the HELP Committee Hearings

By Carole R. Myers

September 7, 2017

Senator Lamar Alexander (R-Tennessee), working with Senator Patty Murray (D-Washington), scheduled four bipartisan hearings on stabilizing the Affordable Care Act (ACA) individual markets which are also known as exchanges. The first two of the hearings were held this week and two more are scheduled for next week.


Five Governors testified today before the Senate Health, Education, Labor, and Pension (HELP) committee, following the five state Insurance Commissioners who testified yesterday. At the end of the day, there was consensus on one potential fix, a growing consensus on another suggested remedy, and an impasse on a third option.


Consensus: The five Governors who testified advocated for the continuation of CSR (Cost Sharing Reduction) payments to insurance companies to cover the cost of out-of-pocket expenses, including co-pays and deductibles, for the lowest income individuals enrolled in the individual market plans. The only disagreement was whether the HELP committee should push for a one year assurance of funding or a multi-year plan.


Growing consensus: State flexibility was promoted across-the-board. Specifically, section 1332 waivers pertaining to certain ACA provisions were promoted. There was a coalescing around several specific procedural changes (e.g., shortened approval process, “me too” applications, allowing Governors and Insurance Commissioners to apply for waiver instead of state legislators, etc.). Views were mixed on whether waivers would apply to only procedural issues, leaving ACA consumer protection some coverage provisions intact, or if protections and coverages could be modified under the waivers.


Discord: Governor Haslam (R-Tennessee) led the charge in requesting federal money for establishing reinsurance plans as a means to reduce premium costs. He and the other Governors indicated there is insufficient time for the states to get reinsurance plans up and running for 2018. Senator Alexander pushed back, indicating he could not pass a bill that included funding for a federal reinsurance plan.


Stay tuned for next week when healthcare stakeholders testify and state flexibility is discussed.  You can listen to the hearings live or on-demand (  Hearings will be held next week on September 12 and 14 at 10 am EDT.


Carole R. Myers, PhD, RN

September 7, 2017 9:00 p.m.

Carole R. Myers

A Refreshing Start on What Truly Made America Great

By Carole R. Myers

September 6, 2017


Photcredit:Library of Congress

I just listened to the opening comments of Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) as they kicked-off the first of four hearing of the Health, Education, Labor, and Pension (HELP) committee hearings over the next two weeks on stabilizing the individual marketplaces.  It was refreshing and encouraging to hear an emphasis on “coming together” and “finding common ground” (remember when this was more common?).  I will be watching to see if the call for bipartisanship is realized.

The challenges are great.  Eighteen million Americans, 6% of all Americans, are enrolled in marketplace plans. The impact of market instability is real and painful to Americans across the country.  Proposed premium rates for 2018 in Tennessee include 21-42% increases because of uncertainty regarding ongoing reimbursement to insurance companies to offset the discounts provided to the lowest income individuals for out-of-pocket costs, including copayments and deductibles.  These reimbursements paid by the federal government, called Cost Sharing Reductions (CSRs) are not bail-outs as they have been characterized by President Trump.  These are justifiable reimbursements to insurance companies for discounts for the poorest marketplace enrollees.  If federal CSR payments are stopped, the insurance companies will recoup cost by increasing premiums for other enrollees.  This is not sustainable.

Another sign of distress is the decline in the number of marketplace plan per counties across the U.S.  Senator Alexander reported that initially only 4% of counties had just one insurer.  This number is now 50%.  Time is another major challenge.  The HELP committee must forge and pass a legislative solution and this policy solution must be approved by Congress by September 27, 2017 to stabilize the individual markets for 2018 as annual enrollment begins.  Americans can do extraordinary things when they have the will and work together.

You can watch live HELP committee hearings via .  Hearings will be held September 7 at 9 am EDT and September 12 and 14 at 10 am EDT.


Carole R. Myers, PhD, RN

September 6, 2017 12 noon


Carole R. Myers

Trump cuts budget to inform people of ACA open enrollment by 90%. Social media responds #SaveACA

By Barbara Glickstein

September 3, 2017

Andy Slavitt, former President Obama’s former head of Medicare and Medicaid, used Twitter to respond to President Trump’s actions to cut 90% of the ObamaCare enrollment outreach program. The funding will be cut from $100 million last year to $10 million this year impacting the ad and in person assistance program.

Slavitt’s first Tweet re the cuts said, “this does not save taxpayers one penny. This is generally money paid out of user fees from insurers being cut.

Pure undermining.”

Later that morning he sent this Tweet:



The response by his followers was swift. Today, he posted this Tweet:



This campaign is growing  as others take to social media to get the word out. Can the public’s social media response fill the void this dramatic cut to the ObamaCare enrollment and reach those in need? Stay tuned. We’ll keep you posted.








Barbara Glickstein
Barbara is a founder of the Center for Health, Media & Policy, as well as a nurse, media guru & activist in New York City. She is the chairman of the board of Project Kesher and a consultant to many health care organizations and creative projects. Barbara tweets and 'grams @blickstein.