WASHINGTON - A bipartisan group of state insurance commissioners on Wednesday sketched out possible common ground where Congress could strengthen the Affordable Care Act's insurance marketplaces, but the chance of lawmakers coalescing around even a modest consensus remained unclear.
At the first of four hearings before the Senate Health, Education, Labor and Pensions Committee, which is trying to forge a small set of improvements to the ACA's shaky exchanges, the commissioners urged senators to guarantee at least two more years of funding for subsidies to insurers, which President Donald Trump has repeatedly threatened to abolish.
They also said the government should give states more flexibility to bypass certain ACA insurance requirements and should re-create a pool of money the law provided during its first years to help buffer health plans from the expense of covering customers with unusually high medical costs.
The ideas advocated by the commissioners amount to a strategy to slow recent spikes in premium rates by some health plans sold on ACA marketplaces and to expand consumers' choices now that major insurers have defected from some marketplaces. The ideas track the basic contours of changes being touted by committee Republicans or Democrats - though not necessarily by both.
The hearings this week and next are part of a compressed timeline the committee has set for itself to negotiate a narrow, bipartisan plan that might help the marketplaces. It is a modest goal but a sharp strategic reversal following events in late July when GOP senators' plans to tear apart much of the ACA imploded spectacularly.
Committee Chairman Lamar Alexander, R-Tenn., opened Wednesday morning's session by saying he wanted to reach an agreement by the end of next week. He pointed out that 31 GOP and Democratic senators had turned out for a private coffee before the hearing to talk about how they might arrive at a consensus - "a remarkable level of interest," he said.
Alexander called on the Trump administration to promise funding for the ACA's "cost-sharing" subsidies through 2018. He also said the government should allow states greater freedom to deviate from a variety of ACA rules, including the benefits that health plans sold through marketplaces must include. Each party "may be reluctant" to support certain elements, he acknowledged, then added, "This is a compromise we ought to be able to accept . . . If we don't, millions of Americans will be hurt."
The committee's top Democrat, Sen. Patty Murray of Washington state, said senators "need to seize this opportunity." But she noted that they have little time for doing so if they hope to influence insurers' rates or participation before Sept. 27, the deadline for companies participating in the marketplaces to sign government contracts for the coming year.
Murray took a less conciliatory tone than the chairman, accusing the Trump administration of sabotage of the sprawling health-care law - such as last week, when officials slashed federal funding of outreach activities and consumer assistance for the ACA's fifth annual enrollment season. Sign-ups start on Nov. 1.
She also quickly reflected the Democrats' differences with their Republican counterparts. For one, the government should promise insurers cost-sharing payments for multiple years, she said.
Other committee Democrats made clear that they expect any compromise to include language or funding aimed at bolstering the enrollment-related activities cut last week. Given Trump's repeated attacks on the law, "if we're going to boost enrollment in 2018, we're going to have to do things to overcome it," Sen. Tammy Baldwin (Wis.) said in an interview.
Republican senators have privately appealed to the White House to consider accepting a limited package to avert further premium spikes for the coming year. One senator, who asked for anonymity to speak frankly, said Vice President Mike Pence seemed open to the idea this week.
The hearings, which continue Thursday with testimony from a bipartisan group of governors, follow Senate Republicans' dramatic failure in late July to overturn central parts of the ACA.Regardless of the new negotiations' fate, the hearings mark the closest collaboration between Republicans and Democrats in years on an issue that has defined their ideological differences perhaps more than any other.
Julie McPeak, who heads the Tennessee insurance department and is the incoming president of the National Association of Insurance Commissioners, said 78 of Tennessee's 95 counties will have only one insurer selling ACA health plans for 2018. She urged Congress to guarantee payments of the cost-sharing subsidies and re-create the federal pool of reinsurance money.
Lori Wing-Heier, director of Alaska's insurance division, said that paying through 2019 would be a minimum, while Washington state's insurance commissioner, Mike Kreidler, would make the payments permanent. The marketplaces are in serious peril because of "the growing uncertainties and actions of the administration," he said.
No matter the result of the panel's efforts, Sen. Sheldon Whitehouse, D-R.I., said its bipartisan approach should become a model for broader attempts by the chamber to improve health care. Ticking off goals - from reducing geographic variations in medical practice to improving care at the end of life - Whitehouse said "there is nothing Democratic or Republican" about them.