Republicans have yet to agree on how they want to replace the Affordable Care Act, but they’re hearing that they might not have much time.
Insurance companies need some details by the end of March as they develop health coverage packages for 2018, panelists suggested at a Senate hearing on Wednesday.
“Insurance markets do not respond well to uncertainty,” said Tennessee Insurance Commissioner Julie Mix McPeak, who along with Janet Trautwein of the National Association of Health Underwriters told lawmakers they should develop an outline by the end of March to avoid creating more turmoil in individual insurance markets already unnerved by political uncertainty in Washington.
The Senate hearing and remarks across town by the Senate’s influential Finance Committee chairman served to highlight divisions among Republicans, who are eager to dismantle the Affordable Care Act but remain worried about the political consequences of taking health care from 20 million Americans without anything in its place.
Sen. Orrin Hatch, R-Utah, told the U.S. Chamber of Commerce in a speech Wednesday that Congress should immediately repeal the taxes that provide subsidies to help 9.3 million Americans pay for marketplace coverage. That’s more than 80 percent of marketplace enrollees with 2017 coverage.
At the same time, Sen. Lamar Alexander of Tennessee, who leads the Senate health committee, said at his hearing that lawmakers must move deliberately so they don’t tilt the national health care system out of balance.
House of Representatives and Senate committees began hearings this week that will serve as the basis for legislation to repeal and replace the 2010 law. Meanwhile, Republicans on the Senate Finance Committee suspended the rules to force a full Senate vote on Rep. Tom Price, President Donald Trump’s nominee for health and human services secretary, who is expected to play a leading role in efforts to overturn the law.
Even as Trump pushes for urgency on repealing the law, panelists testifying before the Senate health committee cautioned Republicans against moving too quickly to take apart the entire health care law, which has extended insurance to 20 million Americans, even as they pointed to problems with it.
Marilyn Tavenner, a former Obama official who helped with the rollout of the program and now leads the insurers’ lobby, acknowledged that certain provisions of the law “have not worked as well as intended,” noting that consumers face significant increases in premiums.
But Tavenner, president and chief executive officer of America’s Health Insurance Plans, argued for stabilizing the markets and urged Congress to preserve the taxpayer-funded subsidies that help low-income Americans afford coverage.
“The absence of this funding would further deteriorate an already unstable market and hurt the millions of consumers who depend on these programs for their coverage,” she told the Senate Committee on Health, Education, Labor & Pensions.
Keeping the taxes may not sit well with Republicans, noted committee Chairman Alexander, even as he pledged that no lawmaker is “talking about repealing anything until there is a concrete, practical alternative to offer Americans in its place.”
Alexander suggested lawmakers will work on various measures including expanding Medicaid and shoring up the individual markets, piece by piece. He noted that in some states there is only a single carrier.
“It’s leaving people in the condition of having a bus ticket with no bus running through town,” he said. “And we’re being told if we don’t act by March or April, in many states . . . there won’t be an insurance company there to sell you insurance.”
But speaking across town to the U.S. Chamber of Commerce, Hatch, who is chairman of the Senate Finance Committee, endorsed a quick repeal of the taxes.
“Some have argued that we should keep all or some of them in place and use them to pay for our eventual replacement package,” Hatch said in prepared remarks. “After spending seven years talking about the harm being caused by these taxes, it’s difficult to switch gears now and decide that they’re fine so long as they’re being used to pay for OUR health care bill.
“All of the Obamacare taxes need to go as part of the repeal process.”
At the hearing, Democrats on the panel accused Republicans and Trump of seeking to sabotage the law, noting that Trump had pulled funding for Affordable Care Act advertising and signed an executive order giving federal agencies more power to delay provisions of the law.
“Certainly to me, that is creating chaos,” said Sen. Patty Murray, D-Wash., who charged that Democrats “can’t repair the roof while the president and Republicans are burning the house down.”
GOP alternatives have proposed giving states “block grants” for Medicaid, but former Kentucky Gov. Steve Beshear, whose embrace of the Affordable Care Act turned his red state into a model for health care, told the panel it would be a bad bet for states.
The Democrat delivered a full-throated defense of the imperiled law Wednesday, telling lawmakers that the GOP proposal to block-grant Medicaid “sounds great” but would cut funding to the states. Congress would be “pulling a “Pontius Pilate routine, washing their hands” and placing the blame on governors, Beshear said.
“The Affordable Care Act isn’t perfect. There are things you can do to improve it,” he said. “But it needs to be done it in a deliberate and thoughtful manner. The one thing we can’t do is go backward.”
He argued that more than 500,000 low-income Kentuckians had secured insurance coverage, giving the state the sharpest decline in the country of residents without health insurance. The state’s uninsured rate dropped from 20 percent to 7.5 percent, lower than the national rate of uninsured.
He also cited what he said were studies that showed an increase in preventive care and substance abuse treatment by Medicaid enrollees and a drop in uncompensated care at hospitals.
“As a result of the ACA, all evidence indicates that Kentuckians are seeing improved health and beginning to reverse decades of poor health statistics,” Beshear said, adding that he “can’t go out of my house or office without someone grabbing and thanking me for having affordable health care, mostly for the first time in their lives.”
Beshear’s successor, Matt Bevin, campaigned on a promise to scale back the law. A spokeswoman for Bevin said Wednesday that the state had seen “unsustainable growth” of 68 percent in its Medicaid program, which “consumes every new dollar of revenue during this time of economic growth – and then some.”
John Stamper of the Lexington Herald-Leader contributed to this report.