Congress looks at legislation to stabilize ACA marketplace

A decision Friday by Anthem to fill in the counties in Virginia that were slated to have no insurers available through the Affordable Care Act exchanges comes as Congress is looking over potential legislation aimed at stabilizing the health insurance marketplace under the ACA.

In the past two weeks, a bipartisan group of senators has been pointing toward a bill that would guarantee federal reimbursement of cost-sharing reduction payments. Insurers are required to make the payments to help patients lower their health care costs and make it easier for states to adjust their programs.

Virginia Sen. Tim Kaine, a Democrat and a member of the Senate’s Health, Education, Labor and Pensions (HELP) Committee that is mulling these efforts, said in an interview Tuesday that the proposals  will lower premiums for people receiving insurance through the Affordable Care Act marketplace because insurers are basing their higher prices on the chance that they will not receive these reimbursements.

“You’ve got companies either pulling out (of the exchanges), or they have to price on the assumption that the payments won’t be made,” Kaine said. “So the premiums are too high.”

By guaranteeing funding of these payments, Kaine said, the companies are likely set to lower their rates.

Kaine’s argument reflects the thinking of Virginia Secretary of Health and Human Resources Bill Hazel, who said Friday that, “it’s inevitable that the plans will have to address (the uncertainty surrounding cost-sharing reductions) in their rates.”

In Anthem’s rate filing with the state’s Bureau of Insurance, the company stated that it would increase premiums by between 42.5 and 64.1 percent. In the filing, Anthem cited the uncertainty surrounding cost-sharing reductions as one of the causes.

That would result in a significant increase for Affordable Care Act enrollees in Shenandoah and Frederick counties and the City of Winchester, all of which can only select Anthem as their choice of insurer.

In an interview Wednesday, Democratic Sen. Mark Warner said that he thought it was likely that Congress would be able to pass the measure guaranteeing the cost-sharing reduction payments and providing states with more flexibility by the end of the month, when insurers are required to provide rate filings to the Bureau of Insurance.

In the interview, Warner was critical of the process Senate Democrats took in passing the Affordable Care Act and that Senate Republicans took in their attempts to pass their own healthcare bill. Warner thought that the stabilization efforts have been moving in a far less partisan way.

“The fact that people are back at it in a bipartisan way, I think, makes a lot more sense,” Warner said.

Kaine mostly echoed Warner’s sentiments, saying that at the HELP committee talks have been moving forward in a bipartisan manner.

“On the committee, I think there’s a strong bipartisan consensus that to stabilize the market, we need to make a commitment on those payments and we need to make sure that the flexibility works,” Kaine said.

But the talks have not been entirely bipartisan. Kaine said that outside of the committee, some senators “are still speaking out against the [cost-sharing reduction] payments.”

Meanwhile, Sen. Orrin Hatch, R-Utah,  a member of the HELP committee, wrote an op-ed in the Washington Post last week stating that he would only support the funding if he received concessions from Democrats.

But even if the cost-sharing reductions measures pass  Congress, there is the question of what happens next. This week, Sen. Bernie Sanders, I-Vermont, released a single-payer healthcare plan that has drawn heavy rebuke from Republicans; senators Lindsay Graham, R-South Carolina, and Bill Cassidy, R-Louisiana,  are pursuing a block grant health care plan that they hope to pass by the end of the month.

Following Anthem’s announcement, Rep. Barbara Comstock, R-McLean,  issued a statement, praising Anthem’s decision while also stating her objections to the Affordable Care Act.

“The status quo is not working,” the statement reads. “Both Obamacare and the House plan I voted against do not address the issues of rising premiums that are affecting working families throughout the District.”

U.S. Rep. Bob Goodlatte, R-Roanoke, said in a statement that Anthem’s announcement is “good news in the short term for Virginians.”

“However, the insurance exchanges created by Obamacare are collapsing,” the statement reads. “From the very beginning, many have said, I included, that this law is simply unworkable and the systems put into place by it will not adequately serve American families. Now, those chickens have come home to roost.”

Neither Comstock nor Goodlatte were made available for an interview. Goodlatte, through a spokesperson, declined to state his position on funding cost-sharing reductions payments; a spokesperson for Comstock did not respond to an email requesting her position on the payments.