September 15, 2017

Senate Races to Stabilize ACA and Extend CHIP

Stabilizing increasing premiums in the individual health insurance marketplace and extending additional funding for the State Children’s Health Insurance Program (CHIP) took center stage at a series of Senate hearings in September.

Sen. Lamar Alexander (R-TN), chairman of the Health, Education, Labor and Pensions (HELP) Committee, announced bipartisan hearings in late July to explore issues plaguing the individual insurance market following the collapse of the Republican effort to repeal and replace the Patient Protection and Affordable Care Act (PPACA), commonly called Obamacare. The Senate HELP Committee held four separate hearings during the weeks of Sept. 4 and Sept. 11 focused on identifying short-term policy solutions to help control the cost of policies sold on PPACA’s insurance exchanges.

The Sept. 6 hearing featured state insurance commissioners from Oklahoma, Washington, Tennessee, Pennsylvania and Alaska. Governors from Massachusetts, Montana, Tennessee, Utah and Colorado testified on Sept. 7.

To bolster the experiences from specific states, the HELP Committee utilized its Sept. 12 and 14 hearings to gain the perspective of a disparate group of affected stakeholders. Some witnesses included Bernard Tyson, chairman and CEO of Kaiser Foundation Hospitals and Health Plan, Inc; Tammy Tomczyk, senior principal and consulting actuary at Oliver Wyman, a Milwaukee-based health insurance consulting firm; Manny Sethi, MD, president of Healthy Tennessee; and Christina Postolowski, Rocky Mountain regional director of Young Invincibles, an organization that attempts to give young adults a voice in the health care debate.

Witnesses stressed variations on four primary short-term policy solutions to control the costs of premiums sold in the individual market:

  • Legislation to fund the cost-sharing reductions (i.e., subsidies given by the federal government directly to help insurance companies cover out-of-pocket costs for low-income beneficiaries for multiple years)
  • A federal reinsurance program to help insurers saddled with an overabundance of costs due to insuring expensive patients with multiple health conditions
  • Greater flexibility in age rating bands (i.e., caps on how much more insurance companies can charge older beneficiaries compared to younger individuals)
  • Reforms to PPACA’s state waiver processes

Debate surrounding legislation to finance cost sharing reductions is particularly contentious because federal courts previously ruled the Obama Administration ran afoul of the Constitution by funding for policy without a Congressional appropriation.

The Senate Finance Committee, which has primary jurisdiction over PPACA, also held a discrete Sept. 12 hearing on rising health insurance premiums for policies sold in the individual market. Chairman Orrin Hatch (R-UT) invited a diverse panel of individuals with viewpoints on either side of the ideological perspective towards former President Obama’s signature domestic achievement to testify. Witnesses included Avik Roy, co-founder and president, Foundation for Research on Equal Opportunity; Edmund F. Haislmaier, senior research fellow, the Heritage Foundation; Andrew M. Slavitt, former acting administrator, Centers for Medicare and Medicaid Services; and Aviva Aron-Dine, senior fellow and senior counselor, Center on Budget and Policy Priorities. These panelists addressed many of the same themes elucidated in the HELP hearings.

Chairmen Alexander and Hatch are under considerable pressure to identify bipartisan solutions to improve PPACA’s individual market because the Senate parliamentarian ruled Sept. 1 that the Fiscal Year 2017 Budget reconciliation instructions or an arcane parliamentary procedure that prohibits a filibuster and allow select bills to pass with a simple majority, will expire Oct. 1. After that date, any bill to amend PPACA not considered under reconciliation will require the higher 60 vote threshold to pass.

The American College of Radiology’s (ACR) Government Relations Office is closely monitoring the effort to amend PPACA because it could include alterations to the state waiver policy or the process of state’s applying for special permission to alter key aspects of the federal health care law. Such changes could affect patient access to preventive screens, such as mammography, virtual colonography and CT lung cancer screening. To date, no legislative language pertaining to short-term fixes to the individual market has been released to the public.

In addition to exploring PPACA cost issues, the Senate Finance Committee held a Sept. 7 hearing highlighting the importance of extending federal funding for the State Children’s Health Insurance Program (CHIP). In 2015 and 2016, CHIP allocated over $25.5 billion to help states insure low-income children who were ineligible for Medicaid.

Current law only appropriates financial resources for the joint state and federal CHIP program through Sept. 30. Absent congressional action, states will no longer receive additional federal funds after the end of this month. The principal witness, Anne L. Schwartz, Ph.D., executive director, Medicaid and CHIP Payment and Access Commission (MACPAC), urged the committee to extend CHIP funding for five years. In response, Senate Finance Committee Chairman Hatch and Ranking Member Ron Wyden (D-OR) announced on Sept. 12 that they have reached an agreement on extending CHIP for 5 years. To date, no definitive figures surrounding the cost of this approach have been released.

The ACR is closely monitoring the CHIP debate to block the use of imaging cuts to finance the extension of this policy. ACR members are encouraged to closely monitor Advocacy in Action eNews for the latest information pertaining to stabilizing the PPACA insurance markets and extending CHIP.