Centrists design bipartisan healthcare stabilization plan; reps throw down gauntlet on turf battle with White House.

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A coalition of roughly 40 House Republicans and Democrats unveiled a slate of Obamacare fixes last week they hope will gain traction after the Senate’s effort to repeal the law imploded, says Politico.com.

The Problem Solvers caucus, led by Tom Reed (R-NY) and Josh Gottheimer (D-NJ), is fronting the effort to stabilize the ACA markets, according to multiple sources. But other centrist members, including Rep. Kurt Schrader (D-OR), and several other lawmakers from the New Democrat Coalition and the GOP’s moderate Tuesday Group are also involved. Their plan focuses on immediately stabilizing the insurance market and then pushing for Obamacare changes that have received bipartisan backing in the past.

The most significant proposal is funding for Obamacare’s cost-sharing subsidies. Insurers rely on these payments–estimated to be $7 billion this year–to reduce out-of-pocket costs for their poorest Obamacare customers.

President Donald Trump has repeatedly threatened to cut off the payments, deriding them as a “bailout” for insurance companies. White House counselor Kelly Conway said on Sunday that Trump will decide “this week” whether to scrap the subsidies–which could make the markets implode.

The bipartisan working group also wants to change Obamacare’s employer mandate so that it applies only to companies with more than 500 workers. Currently companies with at least 50 workers can be hit with a tax penalty if they don’t provide coverage to their workers.

The group also wants to create a federal stability fund–dollar amount unspecified–that states can tap to reduce premiums and other costs for people with extremely expensive medical needs. Both the Senate and House repeal packages contained similar pots of money.

The bipartisan proposal also calls for scrapping Obamacare’s medical-device tax, an idea that has received bipartisan support in the past. Finally, the working group is seeking greater flexibility for state innovation. Obamacare already allows state to seek waivers from coverage rules, but the lawmakers want additional guidance on how states can take advantage of them.

The roll out of their stabilization agenda follows months of private meetings between various members involved in the House’s centrist caucuses about ways to stabilize Obamacare if the GOP’s repeal effort sputtered.

The push was intensified after the Senate’s repeal collapsed in the wee hours of Friday morning when Sens. Susan Collins (R-ME), Lisa Murkowski (R-AK), and John McCain (R-AZ) joined with all Senate Democrats to reject the GOP’s “skinny repeal.”

Steve’s Take:

I was wondering if and when the day might come when Congress began to act more like the separate and equal branch of the US government I had grown up believing it was. Then, out of the woods, I heard the voices of Reps. Josh Gottheimer and Tom Reed pleading in unison, “Lets stop the bickering and fix the healthcare system.”

At first, I doubted my hearing (and even sanity). But right there in The New York Times was the single voice of two representatives from across each’s respective political aisle, speaking as though they actually weren’t bitter enemies pledged to never, ever agree on anything as far as managing the US healthcare system was concerned.

Here’s what Reps. Gottheimer and Reed said, and I warn you, it’s not fake news, but nevertheless may make you doubt your own ears.

“If either of us were building the American health care system from scratch, we’d probably end up in different places. We have contrasting ideas–one of us is a Democrat, the other a Republican–about what ails the system and how to reshape it. But this is not the time for more partisan fighting. It’s time to build a better system, even if incrementally, because that’s what the American people deserve. It’s time to put aside blame and stabilize a healthcare marketplace where premiums are expected to rise by more than 15% in most states and millions of people are worried about obtaining or affording coverage.

This week the 43-member House Problem Solvers Caucus–which we lead and which is almost evenly split between Democrats and Republicans–released a carefully drafted compromise to shore up the struggling insurance exchanges.

Ultimately, everyone had to give a little and endorse provisions that purists in both our parties may not like. This is how American democracy is supposed to work, even if it has not for quite some time.

Our proposal first focuses on the most urgent crisis: the skyrocketing cost of individual health insurance premiums. The Trump administration is considering suspending cost-sharing payments that defray out-of-pocket payments like deductibles and co-payments for people earning less than 250% of the poverty line. Because of uncertainty about this subsidy, insurers have said premiums could rise by 15% or more.

On Aug. 16, insurers must submit their 2018 rates to state regulators for approval; many may be forced to leave the individual marketplace altogether.

Our plan would stabilize markets by making the cost-sharing payments mandatory and thereby prevent rates from rising sharply.

Second, we provide a relief valve to help states deal with the high cost of pre-existing and chronic conditions. The costliest 5% of patients account for nearly half of all health care spending in the country. We propose a dedicated stability fund–essentially a form of reinsurance–that states could use to reduce premiums and limit losses for providing coverage for these high-cost patients.

Third, our proposal provides relief to certain businesses from the mandate that they provide insurance to full-time employees. It also defines “full time” as a 40-hour workweek to discourage businesses from manipulating employees’ weekly hours to skirt the mandate.

More than 90% of large businesses offered health care before the Affordable Care Act, and studies show that they would continue to do so under this change; others would move to find employee coverage in the individual marketplace.

Fourth, our plan eliminates the Medical Device Tax, an excise charge of 2.3% that is often passed onto consumers and reduces funds for research and development.

And finally, we provide states with additional flexibility to enter into agreements–such as enabling the sale of insurance across state lines–that would provide more choice and lower costs. This proposal would not increase the federal deficit, offering several options to offset the new spending.

Our plan isn’t intended to rectify everything that’s wrong with American health care. We aim to solve an immediate problem and move past a seven-year stalemate in Washington that has featured Republicans trying to repeal the current healthcare law, Democrats trying to preserve it and neither side willing to discuss anything in between.

That approach has led us to our current moment, in which no one is happy with the status quo, least of all the American people, whose trust and confidence in Washington weakens every day that we spend fighting instead of solving real problems.

Health care is one of those problems–and a textbook example of why we formed the Problem Solvers Caucus this year. We all knew the partisanship in Washington had gotten out of control and felt the need to create a bipartisan group committed to getting to “yes” on important issues. We have agreed to vote together for any policy proposal that garners the support of 75% of the entire Problem Solvers Caucus, as well as 51% of both the Democrats and Republicans in the caucus.

If Washington does not act to stabilize the insurance exchanges, many families we represent will lose coverage or be hit with premiums they can’t afford. This isn’t conjecture. If that does happen, people will be justifiably livid that Republicans and Democrats in Congress did nothing to stop a train wreck we all saw coming.

There is a growing recognition on Capitol Hill that something must be done, as evidenced by last week’s announcement from Senator Lamar Alexander–the Tennessee Republican who is chairman of the Senate Health, Education, Labor and Pensions Committee–that he will soon hold hearings focused on repairing the individual insurance market.

Our proposal isn’t perfect, but it represents the first and only serious bipartisan healthcare proposal released in this Congress. We hope our colleagues in the House and Senate, as well as the White House, will use our plan as the foundation for the healthcare solution that America desperately needs and deserves.”

Bottom Line:

My hearing and sanity aside, this clear repudiation of President Trump’s trashing of the legislative branch upon any sign of disloyalty to his political agenda and bidding gives me some hope.

Certainly, Obamacare needs the changes to some of the structure its creators built into the program at its outset, knowing full well that they couldn’t possibly foresee every design flaw that would manifest over time. These flaws are well known and acknowledged by, yes, Democrats.

Steve's Take: Courageous #Republican centrists tell @realDonaldTrump to go fly a kite Click To Tweet

Of course, after the summer vacation on Capitol Hill is over (or even before), Mr. Trump may come back swinging harder than ever, demanding blind loyalty again to the Obamacare repeal and replace effort.

That’s going to be harder than ever, though, what with the courageous Republican centrists essentially telling the President to go fly a kite. Legislation is their turf and I sense a strong resolve growing to assert their Constitutional claim to it with a single voice, enunciated last week by the likes of Messrs. Gottheimer and Reed.