Lamar Alexander and Patty Murray are circulating a new “ACA stabilization” plan that in some ways is more ambitious than past efforts and takes into account the repeal of the individual mandate penalty. The senators are trying to get it into the omnibus spending bill Congress wants to pass by March 23.
But success is not very likely at this point. It’s not impossible given all the horse-trading that has to happen to get a huge omnibus spending bill passed, and Alexander, in particular, is persisting. But it definitely is a long shot. Republicans want to add abortion restrictions that are not acceptable to Democrats. Also, a cluster of conservatives – a handful in the Senate and more in the House – are opposed to spending any money fixing the Affordable Care Act or, as they call it, “bailing out” insurers.
One reason the effort is not totally dead: the plan would bring down premiums next year, and that’s an attractive thing for politicians to go home and talk about before facing voters in November. A preliminary Congressional Budget Office analysis estimates that premiums (which are expected to rise because of the mandate repeal and the introduction of non-ACA compliant health plans) would be 10 percent lower in 2019 on average if this legislation were enacted, and by 20 percent on average in the following two years (with some variability among states). Some private analysts estimate higher. Major elements of the Alexander-Murray proposal include:
- State-based reinsurance programs via 1332 waivers and “invisible” high-risk pools: $10 billion of federal funds each year for 2019, 2020, 2021.
- Greater flexibility in health plan design for states wishing to have 1332 waivers.
- A speedier, streamlined federal waiver review system.
- More access to catastrophic coverage – offering so-called “copper” plan to joining the other “metal” tiered plans (bronze, silver, ).
- Restoration of cost-sharing reduction subsidies through 2021 (some retroactive to their cessation in October 2017).