Sens. Susan Collins and Lamar Alexander (Photo: Gregory Rec / Portland Press Herald via Getty Images)

This week is likely Congress' last chance to pass legislation stabilizing the Affordable Care Act's insurance markets, and it's anyone's guess what lawmakers will end up doing. On top of the political uncertainty, the policies they're considering are more complicated than they seem, and the results could be a mixed bag.

Why it matters: What Congress does here will have a big impact on millions of people's insurance premiums, and on insurance companies' decisions about whether to keep participating in these markets.

The big picture: Various iterations of an ACA stabilization proposal have been floating around since September. But the spending bill Congress is taking up this week might be the last good vehicle this year to finally pass something.

Between the lines: Showing insurers that Congress at least wants to try to help this market function might be just as important as the specifics of what it does.

  • "Doing something that improves health plan certainty about the market next year, particularly around their costs, and ensure the market works as designed ... may make a difference in whether regions of the country have participating insurers in 2019," Chris Sloan of Avalere said.

The details: There's no bipartisan deal yet, but GOP Sens. Lamar Alexander and Susan Collins are pitching a plan with three years of funding for reinsurance and for the Affordable Care Act's cost-sharing reduction payments (known as CSRs), along with more flexible state waivers and expanded access to less comprehensive plans.

What they're saying:

  • Funding CSRs would mainly benefit the federal government, by reducing spending on the ACA subsidies that help people pay their premiums. That would cause some subsidized consumers to pay more, while unsubsidized consumers would pay less for certain plans.
  • "You can claim you reduced premiums by funding the CSRs, but that reduction of premiums doesn’t really help anybody," said Chris Condeluci, a Republican health policy lawyer.
  • Funding a federal reinsurance program would lower premiums for everyone — the subsidized and unsubsidized alike. But because of the way the premium subsidies are structured, people who receive them probably won't notice the difference.

The bottom line: "Funding CSRs will increase net premiums for many subsidized enrollees, while generally not affecting unsubsidized enrollees," said Matt Fiedler of Brookings. "Reinsurance will benefit unsubsidized enrollees by reducing sticker premiums, but not subsidized enrollees because their tax credits will fall ... when sticker premiums decline."

Go deeper

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It hasn't backed a Democrat for president since 1992, but Georgia's changing demographics may prove pivotal this year — not only to Trump v. Biden, but also to whether Democrats take control of the Senate.

Why it matters: If the fate of the Senate did hinge on Georgia, it might be January before we know the outcome. Meanwhile, voters' understanding of this power in the final days of the election could juice turnout enough to impact presidential results.

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The most notable part of Thursday’s presidential debate on climate change was the fact it was included as a topic and assumed as a fact.

The big picture: This is the first time in U.S. presidential history that climate change was a featured issue at a debate. It signals how the problem has become part of the fabric of our society. More extreme weather, like the wildfires ravaging Colorado, is pushing the topic to the front-burner.

Finally, a real debate

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A more disciplined President Trump held back from the rowdy interruptions at tonight's debate in Nashville, while making some assertions so outlandish that Joe Biden chuckled and even closed his eyes. A Trump campaign adviser told Axios: "He finally listened." 

The result: A real debate.

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