On March 19, Senators Lamar Alexander (R-TN) and Susan Collins (R-ME), along with Representatives Greg Walden (R-OR) and Ryan Costello (R-PA) proposed the Bipartisan Health Care Stabilization Act of 2018 in an effort to stabilize America’s health insurance market. However, the proposal did not make it in to the spending bill passed on March 23. The plan to amend the Affordable Care Act (ACA) and fund cost-sharing reductions subsidies was not successful because the parties were not able to come to an agreement after Democrats insisted that this package be exempt from  “Hyde amendment” language, typically used in appropriations legislation, to prevent federal funding from being used for abortions.

Since October, Senators Alexander, Collins and Patty Murray (D-WA) have been fighting to enact a bill that would stabilize the ACA insurance markets and lower premiums. The plan was designed to stabilize the ACA insurance exchanges in the following three ways:

1. Allow for “State Innovation Waivers,”
2. Appropriate money for cost-sharing payments, and
3. Allow more individuals to purchase lower-premium “copper plans.”

The State Innovation Waivers would have allowed states to offer value-based insurance plans with increased flexibility regarding the cost-sharing and other plan design elements, to redirect federal funding to use for reinsurance programs or for high-risk pools, and to have a streamlined process for applying for a waiver. The proposal would have reauthorized the ACA’s cost-sharing reduction payments and created a $30 billion reinsurance program. Before President Trump announced last year that the federal government would no longer be making cost-sharing reduction payments, these payments were the way in which the federal government could reimburse insurance companies that insured high-risk individuals. Lastly, the proposal would have expanded those individuals eligible for lower premium “copper plans,” which are also referred to as catastrophic health plans. Currently, only individuals under the age of 30 or those who meet a hardship exemption can purchase these copper plans. The proposal sought to remove the age or hardship qualification and allow anyone to purchase the lower-premium plans, with the aim of keeping healthy individuals in the insurance pool.

Senators had planned to come to a bipartisan agreement and include the stabilization proposal into the spending bill before health insurers start setting their 2019 premium rates. Republicans refused to remove language that would bar insurance policies sold on the ACA exchanges from covering abortions, and Democrats refused to approve the proposal with this language. Despite this failed attempt, Senator Murray stated that she believes Democrats and Republicans are “frustratingly close” to an agreement. For now, the burden will be on states and health insurers to find a way to lower insurance premiums and keep individuals participating in ACA’s health insurance exchanges.

To view the proposal, click here.