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.