Senate Kicks Off Substantive ACA Fix Hearings

On Wednesday, September 6, the Senate HELP Committee kicked off a series of hearings on a possible bipartisan bill to address pressing issues with the individual market under the Affordable Care Act (ACA). The first hearing, the senators heard from five state insurance commissioners from both parties. Notably, the hearing largely avoided partisan rhetoric on the ACA and focused on how substantive short-term solutions should be implemented. Senator Alexander expressed his wish for draft legislation to be introduced next week. More importantly, further insight into what senators may agree on was provided in the first hearing.

Block Grants and the Graham/Cassidy Proposal

Before we dive into what could be included in a stabilization bill, it is worth noting the repeal/replace movement is not entirely off the table. The parliamentarian noted last week the reconciliation process for providing a repeal bill will end on September 30, adding several weeks before we see any finality. Several senators also expressed their interest in the Graham/Cassidy proposal, continuing to push for block grants. McCain expressed his support for Graham/Cassidy, making it a possibility this bill could surface and scrape through with a Pence tiebreaker.

Cost Sharing Subsidies

 Everyone agreed cost sharing subsidy funding was necessary in any stabilization bill in order to provide clarity around rates for 2018. The remaining question is how many years this Congress would agree to fund. Senator Alexander expressed his wish for one-year funding, while most others agreed at least two years was necessary to provide rate clarity for 2018 and 2019.


Commissioners all agreed a reinsurance program was necessary, and the discussion turned to a fairly technical examination of possible ways a federal reinsurance program could be funded. Senators requested comment on how much funding was necessary and how to best calculate reinsurance claims. One point of disagreement, however, is whether the reinsurance program should be run through the federal government or states. Senator Alexander argued for the use of state waivers, while several commissioners called for federal funding.

Enrollment Outreach

Interestingly, increased enrollment outreach was a theme repeated several times during the hearing with requests for additional funds and outreach support. However, Senator Alexander did express his concerns with Health and Human Services’ (HHS’) oversight over navigators and assisters given HHS’ concerns with the amount of money spent on the program with lackluster results.

1332 Flexibility

All the commissioners were in support of greater waiver flexibility, however, could not agree on the extent of the flexibility. Democrat commissioners cautioned about overstepping consumer protections around premiums and coverage, while Republican commissioners requested changes to age ratings and essential health benefits. Given the wide range of testimony, this area will likely be the point of most contention during the drafting of legislation. Democrats will likely concede to a quicker, easier waiver approval process. It is unclear whether there will be any movement on the position of safeguarding consumer protections.

Stay tuned for further developments during this hearing-packed week.



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