Graham-Cassidy Vote Stalls; Medical Groups Urge Bipartisan Solution

Originally published by Healio on September 27, 2017.

With another attempt at repealing the Affordable Care Act on hold, leaders of the AAFP, American College of Physicians and other medical groups are pleading with lawmakers on both sides of the aisle to work together on health care reform.

“We urge the Senate and the House to move on, for good, from their efforts to roll back coverage,” the AAFP, American College of Physicians, AAP, American Congress of Obstetrics and Gynecology, American Osteopathic Association and American Psychiatric Association said in a joint statement. “Instead Congress should strive for bipartisan agreement, through regular order, to make improvements to our health care system.”

A bill that has such bilateral support was introduced by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) earlier this year. This plan would include funding for the cost-sharing reductions, stabilize individual health care markets and include greater flexibility for states in approving health insurance policies. Alexander said yesterday he would revisit some of these ideas.

There are other health care plans on the table, including the Individual Health Insurance Marketplace Improvement Act, that was introduced by Senator Tim Kaine(D-VA) and Tom Carper (D-DE) earlier this year. This bill would lower premiums and create a permanent reinsurance program for the individual health insurance market like those used to lower premiums and increase competition in the Medicare Part D program. Similar to Alexander and Murray’s plan, it would help stabilize the individual health care marketplace, which has been a volatile subject on health care reform.

Though a timeframe for future health care discussions remains unclear, the AAFP, American College of Physicians and the other medical groups said certain decisions must be made right away.

“Immediately, we believe that Congress must do what they can to execute open enrollment in a good faith manner,” the statement read. “Millions of Americans remain unaware of the types of assistance available to help them afford and enroll in health insurance. Congress must adequately fund education and outreach efforts to tell consumers about the assistance available to them.”

Additionally, the medical groups urged Congress to move swiftly to extend federal funding for several health care safety net programs, which are set to expire on September 30.

“We call on Congress to take immediate action to enact a five-year extension of funding for the Children’s Health Insurance Program (CHIP) in order to ensure that our patients have ongoing access to this crucial affordable and comprehensive coverage option,” the groups wrote. “Failure to extend funding would put health coverage for millions of children and pregnant women in jeopardy.”

These societies encouraged lawmakers to make them part of the health care discussion.

“We look forward to working with Congress on these immediate concerns and on other health care reforms that would improve and not harm the health of all Americans,” the groups stated. – by Janel Miller

Disclosures: Healio Family Medicine was unable to determine relevant financial disclosures prior to publication.

PERSPECTIVE

At least for now, the idea of a wholesale repeal and replace of the Affordable Care Act is behind us. Senate leadership has made it clear that they are unwilling to support a bill that pairs health care with tax reform in the FY 2018 reconciliation bill, which is the only avenue available for the GOP to prevail with only 50 votes.

With that said, Congress and the administration can, and likely will, continue to undermine the ACA. Marketplace instability is a serious issue. To date, the administration has destabilized the marketplace by cutting the open enrollment period in half and by cutting 90% of the funding for its advertising budget. President Trump is further threatening the stability of the marketplace by only committing to making cost-sharing reduction payments on a month-to-month basis. These actions only add to the stress of already jittery insurers, who are obligated to make the subsidy payments to consumers, regardless of whether they are paid by the government. All this uncertainty affects health care providers and their patients.

Similarly, the administration is undermining the Medicaid expansion program through the state waiver process. Flexibility and the delegation of authority to states is a major theme in Congress and the administration’s health care policy platform. The Trump administration has already signaled a willingness to consider waiver proposals that include conditioning Medicaid expansion eligibility on work requirements, monthly income verification and eligibility renewals, and drug screening. All of these proposals serve to eliminate health care coverage for millions of our most low-income and vulnerable citizens.

With partisan efforts to repeal the ACA behind us, the likelihood that Sens. Alexander and Murray will be able to negotiate a compromise to stabilize the private insurance marketplace has increased dramatically. That is not to say that it will be an easy fix to get through Congress.

The good news is that bipartisan discussions and hearings with insurers and governors are already happening, because there is agreement that a fix for the subsidy issue needs to happen.

For some more moderate members of Congress, the subsidy fix isn’t enough and reforms must include a reinsurance program that could further help stabilize premiums. More conservative members may only support a temporary fix with a trade-off, such as giving states additional flexibility to establish marketplace insurance standards.

Sens. Alexander and Murray will have their hands full brokering a deal. Millions of lives depend on it. Who gets the blame should the effort fail remains an important question for leadership in both parties.

• Robert Greenwald, JD
• Faculty Director, Center for Health Law and Policy Innovation
  Clinical Professor of Law, Harvard Law School, Cambridge, Massachusetts
  

Disclosures: Greenwald reports no relevant financial disclosures.