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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

Updated 43 mins ago - Energy & Environment

Thousands without power as "hazardous" winter storm lashes East Coast

Satellite imagery of the Northeastern U.S. taken by NOAA on Jan. 17. Photo: NOAA

A major winter storm lashed much of the East Coast Sunday and Monday, causing widespread power outages and disrupting travel over the holiday weekend.

The latest: Authorities in North Carolina confirmed that two people died in a car crash and that they responded 600 vehicle accidents during the storm on Sunday, per the Washington Post.

CDC director says COVID-19 messaging should have been clearer

Rochelle Walensky. Photo: Stefani Reynolds-Pool/Getty Images

Rochelle Walensky, director of the Centers for Disease Control and Prevention, said in an interview with the Wall Street Journal that the messaging around the COVID-19 pandemic and changing guidance should have been clearer.

State of play: Walensky is being coached by media experts and is planning to have more press briefings by herself in order to ensure that CDC is seen as an independent, scientific entity, rather than as a political one, the Journal reports.

2 hours ago - World

UAE asks U.S. to reinstate Houthi terrorist designation after attack

Secretary of State Tony Blinken (left) listens to United Arab Emirates Foreign Minister Sheikh Abdullah bin Zayed al-Nahyan during a joint news conference at the State Department iin October. Photo: Andrew Harnik/Pool/AFP via Getty Images

Emirati Foreign Minister Abdullah Bin Zayed asked Secretary of State Tony Blinken in a phone call Monday to re-designate the Houthi rebels in Yemen as a terrorist organization, a senior Emirati official told Axios.

Why it matters: Less than a month after he assumed office, President Biden rolled back the Trump administration’s decision to make the designation. He said it hampered humanitarian assistance to the Yemeni people. Since then, the Houthis have escalated their attacks against Saudi Arabia and other countries in the region — including an attack Monday in Abu Dhabi.

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