Oct. 19, 2017 UPDATE ...12 Republicans and 12 Democrats sign on to cosponsor bill to stabilize state insurance markets in 2018, 2019

A group of 24 senators -- 12 Republicans and 12 Democrats led by Senate HELP Committee Chair Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.)-- today released short-term bipartisan legislation to stabilize premiums and access to insurance in individual health insurance markets.

In a joint statement, Alexander and Murray said: "We have reached an agreement on bipartisan legislation that will extend cost-sharing reduction payments during 2018 and 2019, protect consumers facing higher premiums this year, and give states meaningful flexibility to create greater choices among health insurance policies in the individual health insurance market."

In addition to Alexander and Murray, the bill was cosponsored by Republican Senators Mike Rounds (R-S.D.), Lindsey Graham (R-S.C.), John McCain (R-Ariz.), Bill Cassidy (R-La.), Susan Collins (R-Maine), Joni Ernst (R-Iowa), Lisa Murkowski (R-Alaska), Charles Grassley (R-Iowa), Johnny Isakson (R-Georgia), Richard Burr (R-N.C.), and Bob Corker (R-Tenn.), and Democratic Senators Angus King (I-Maine), Jeanne Shaheen (D-N.H.), Joe Donnelly (D-Ind.), Amy Klobuchar (D-Minn.), Heidi Heitkamp (D-N.D.), Al Franken (D-Minn.), Joe Manchin (D-W.Va.), Tom Carper (D-Del.), Tammy Baldwin (D-Wis.), Claire McCaskill (D-Mo.), and Maggie Hassan (D-N.H.)

The bill language is here. A section-by-section summary is here.

AMA Supports Bipartisan Plan

Also, on Oct. 19, American Medical Association President David O. Barbe, MD, released the following statement:

"The American Medical Association supports the compromise proposal developed by Senators Lamar Alexander and Patty Murray to restore the cost-sharing reduction payments needed to stabilize the individual and non-group health insurance markets through 2019. Multiyear action is needed to maintain the availability and affordability of individual health insurance plans that millions of Americans count on for access to the medical care they need. We are pleased the proposal includes additional health plan options and provides needed funding for outreach, education, and enrollment assistance, while maintaining key guardrails to protect patients as part of the state waiver process. We urge all members of Congress to support the Alexander-Murray proposal."

ACEP Statement on Legislation

President of the American College of Emergency Physicians Becky Parker, MD, FACEP, released the following statement:

"ACEP supports the bipartisan Alexander-Murray legislation introduced today, which will provide critical stability for the individual health insurance marketplace, ensuring that millions of Americans have continued access to the health coverage they need and deserve.

"This legislation is a good-faith bipartisan effort that will help limit increases in health insurance premiums and preserve important consumer protections, such as the Essential Health Benefits package that includes emergency services, while also providing additional flexibility for states to implement innovative approaches to coverage. For the tens of millions of patients that receive care in the emergency department each year, the Alexander-Murray agreement provides much-needed assurance that their care will continue to be covered.

"Further, this approach is proof that lawmakers on both sides can collaborate on patient-centered solutions that help improve our entire healthcare system. By providing this important short-term stability, policymakers, physicians, providers, and other stakeholders and experts can continue working to address the other challenges facing our healthcare system. ACEP applauds Senators Alexander and Murray for their bipartisan agreement and urges Congress to act quickly to enact this vital legislation."

Oct. 17, 2017 ... HELP Chairman Sen. Lamar Alexander (R-Tenn) and Ranking Member Patty Murray (D-Wash) have released a short-term bipartisan compromise to restore funding for subsidies that help low income Americans with out-of-pocket health insurance costs while giving states more flexibility in Affordable Care Act implementation.

The measure would restore the cost sharing subsidies to insurers for two years that President Donald Trump cut last week, calling the payments a bailout for big insurance companies. While the payments cost the federal government billions, they help low income Americans with healthcare co-pays and deductibles. President Trump indicated he might get behind the plan as a short-term option while more sweeping repeal and replace efforts continue ... but then he tweeted the opposite.

In addition to restoring the cost-sharing funding, Democrats also secured money to help individuals enroll in the ACA. On the flip side, the bipartisan compromise gives states more flexibility in implementing some ACA rules and makes it easier for states to obtain waivers. The plan also paves the way for states to add a 'copper' plan to their offerings, which would allow adults over age 30 to purchase less expensive catastrophic plans. The measure changes current wording to allow states waivers to offer plans "as affordable as" ACA options to those with "comparable" affordability. The plan continues the mandate to cover all while maintaining price equity between those who are healthy and those with pre-existing conditions.

It is uncertain whether the measure will make it to the floor for a vote after a lukewarm reception. Some Republican lawmakers expressed concern the plan sustains Obamacare while others indicated they have moved on to tax reform. On the opposite side of the aisle, the Democratic Caucus met the plan with some receptiveness, albeit tempered. As one senator noted, "the devil is certainly in the details."

In a floor speech later on Tuesday, Alexander said the bipartisan bill would help stabilize the individual health insurance marketplace while creating more choice for coverage.

"Imagine yourself, a 45-year-old songwriter in Tennessee who loses her job, has three kids, and goes out into the individual market and finds out she can't buy health insurance because no company is offering it. If we do not act, this is the kind of consequence we are talking about," he told colleagues.

"Our legislation is based on the four bipartisan hearings and other meetings that our committee held last month and engaged nearly 60 senators," Alexander said. "According to witnesses at our hearings and according to the Congressional Budget Office, without these cost-sharing reduction payments, premiums will rise, the debt will increase by nearly $194 billion over ten years, and up to 16 million Americans may find themselves living in counties where no company sells insurance in the individual market."

He continued, "Witnesses also testified that one way to lower costs for consumers is to give states more flexibility than the Affordable Care Act now allows to design health insurance plans give consumers more choices. We have purposely limited our proposal to these two things - first, two years of temporary cost-sharing payments, and, second, amendments that would give states meaningful flexibility in using section 1332 innovation waiver that is already a part of the Affordable Care Act."

Alexander noted only about 6 percent of Americans, or about 18 million people, get their insurance in the individual market, but he said "every single one of them finds their health insurance important ... and every single one of them is terrified by the skyrocketing premiums and possibility that they may not able to buy insurance at all if we don't act." Alexander added, The best course is to take this limited bipartisan first step that to avoid the chaos that could occur during 2018 and 2019 if premiums continue to skyrocket and millions of Americans find themselves without a way to purchase health insurance."

Alexander concluded, "Senator Murray and I hope that we can present this legislation to Senator McConnell and Senator Schumer, with the support of a significant number of senators. We hope that it will pass, the House of Representatives will agree to it, and the president will sign it. I have had encouraging discussions with President Trump, who called me on two different occasions encouraging me to work with Senator Murray to come to a bipartisan agreement. I'm grateful to him for that encouragement and I'm grateful to her."

Alexander's full remarks on the Senate floor are available here.

Corker Signs on as a Cosponsor

WASHINGTON, October 18, 2017 - U.S. Senator Bob Corker (R-Tenn.) today cosponsored bipartisan legislation to stabilize the individual health insurance market and begin to lower the cost of premiums. The bill was authored by Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.).

"Congress has a responsibility to ensure that families in Tennessee and across our country who receive health insurance through the individual market do not continue to be burdened with rising premiums and fewer choices," said Corker. "This bill is a temporary fix that will give states the flexibility they need as we work to develop a health care replacement that will stand the test of time and work better for the American people, and I applaud Senator Alexander's leadership on this important issue."