May 11, 2017

Senate GOP united on one thing: lowering premiums

Pablo Martinez Monsivais / AP

Senate Republicans have spent three days throwing around all kinds of health policy ideas, but they're all united around Thursday's topic du jour: lowing premiums.

"There's no reason that premiums on the individual market should double and triple in a state like mine. There was no reason for that other than Obamacare," Sen. Ron Johnson of Wisconsin told reporters. "We need to diagnose that then figure out what policies we can agree on to bring those premiums down."

There are two emerging ideas as to how to do that: Tinker with the Affordable Care Act's consumer protections — which is both better understood by members but more controversial — or automatically enrolling people in a basic health plan.

Reforming or repealing the Affordable Care Act regulations: This is the main way the House health care bill tackles premiums. It allows states to opt out of the ACA's essential health benefits and, in limited circumstances, its ban on charging sick people higher premiums.

But senators have varying opinions on whether or not they should do this. It's also questionable whether they'll be allowed to under Senate rules.

  • Johnson: In order to bring down premiums, the regulations "absolutely" must be addressed. When asked whether he would guarantee pre-existing conditions will be covered, with sick and healthy people paying the same premium, he said, "I'm guaranteeing nothing other than my effort to try and bring those premiums down."
  • Health, Education, Labor and Pensions Committee Chairman Lamar Alexander: "We would like to move more decisions out of Washington, back to the states, about regulating insurance."
  • Sen. Bob Corker: "I have to believe that when you mandate ten essential health benefits in a rigid way that it affects the cost of premiums." But, Corker said, pre-existing conditions protections are "something that has to stay ... It does drive up costs for others, but to me, I'm perfectly comfortable and appreciative of the fact that we've gotten to a place where people [who] have pre-existing conditions can be covered."On charging sick people higher premiums: "I would hope that we would be in a place where regardless, if it's just based on the luck of the draw that you have these pre-existing conditions, then I would hope people would pay the same premiums as others in that case."

Another alternative: Auto-enrolling people in a very basic, bare-bones health plan. This would essentially be catastrophic coverage that is paid for by a person's federal tax credit, but people would have to opt out instead of choose to buy it. This, in theory, would get a lot more healthy people in the marketplace and help balance out costs.

  • Sen. Bill Cassidy: "Your best way to lower premiums is to expand the risk pool ... Auto-enrollment would allow expansion of the risk pools."
  • A senior GOP aide said auto-enrollment is "absolutely" the key to lowering premiums. The aide said Sen John Cornyn, the majority whip, spoke about the idea at Thursday's working group meeting and it was "well received."
  • Another senior GOP aide told me that auto-enrollment "is one of many ideas being examined for their utility and impact ... There's no leading options yet; lots for members to explore and implications to assess before any decisions will be made."
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