2017-10-25 19:20:06 UTC

AGA Supports Bill to Stabilize Individual Market

Oct. 26, 2017

This bipartisan agreement is good first step to ensure patients continue to have access to quality care.

Recently, the Senate Health, Education, Labor and Pensions (HELP) Committee Chair Lamar Alexander, R-TN, and Ranking Member Patty Murray, D-WA, released a bipartisan agreement to stabilize the individual insurance market and to continue to provide cost-sharing reduction (CSRs) payments to insurers for two years. These payments reduce the out-of-pocket costs of insurance for those individuals with incomes between 100 and 250 percent of the federal poverty level. 
The bipartisan agreement currently has 24 cosponsors — 12 Republicans and 12 Democrats. Unlike previous proposals to repeal and replace the Affordable Care Act (ACA), the agreement has thus far received support from the health care community. AGA has lent its support to the agreement, since this is the first bipartisan solution that adheres to AGA’s health care reform principles and provides key patient protections. This agreement, although not perfect, is the first step in stabilizing the individual market and ensuring that people can continue to have access to health care. It also demonstrates that a bipartisan solution is plausible and hopefully if enacted, can be built upon to improve health care coverage.
The Alexander-Murray agreement is the culmination of months of hearings and negotiations among the Senate HELP Committee and includes five key provisions:
  1. CSR Payments. Includes two years of funding for cost-sharing reduction payments. Without these payments, the Congressional Budget Office (CBO) estimates that premiums in the individual market will rise by 20 percent.  
  2. State Flexibility for 1332 Waivers. States would be allowed to use existing 1332 waivers to alter some of the ACA’s insurance parameters in the individual market. Waivers could be used to approve insurance plans outside of Obamacare’s insurance regulations as long as they maintain the ACA’s coverage requirements and are of “comparable affordability” to plans in the current exchanges. This also protects essential health benefits and protections for people with pre-existing conditions, since the bill requires any new coverage requirements to be at least as comprehensive as they would have been without the waiver and related to ensuring that a comparable number of individuals receive coverage. 
  3. Restored Funding for Outreach and Advertising. Restores $106 million in ACA outreach and advertising funding to publicize open enrollment period.
  4. Expanded Access to Catastrophic Coverage Plans. Loosens restrictions on access to catastrophic health care plans, known as copper plans. Allows all individuals, not just people under the age of 30 as is current law, to purchase these plans regardless of age or income levels.
  5. Interstate Compact Regulations. Requires Health and Human Services (HHS) to issue regulations regarding health care choice compacts that would allow individuals to purchase coverage across state lines.
The CSRs have been the subject of a legal dispute and the Trump administration recently announced that they were ending the payments to insurers, yet insurers are still obligated to provide eligible enrollees with the discounts regardless if the federal government funds them. There is concern that premiums could rise in the individual market, enrollment will be reduced and insurance participation will continue to decrease.
Contact your legislator to show your support for the Alexander-Murray agreement. Call the Capitol Switchboard at 202-224-3121. Ask the operator to connect you with the senators from your state and tell them:
  • Your name and hometown.
  • That you urge the senator to support the Alexander-Murray agreement to stabilize the individual insurance market and to continue to provide cost-sharing reduction (CSRs) payments to insurers for two years.
AGA continues working with our allies on Capitol Hill to help shape an outcome that is in the best interest of gastroenterology and our patients. Patient access to quality health care, preventive screenings and specialty care are AGA priorities. 

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