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HELP Ranking Member Patty Murray and Chairman Lamar Alexander in a hearing. Photo: Alex Brandon/AP

Members of the Senate HELP Committee honed in on idea today that might help resolve the biggest sticking point (so far) in their effort to stabilize the Affordable Care Act. Republicans and Democrats are divided over how much leeway states should have to waive certain provisions of the ACA, including some of its most popular consumer protections.

Former Health and Human Services Secretary Michael Leavitt raised a middle-ground approach that caught the attention of HELP Chairman Lamar Alexander: keep federal guidelines around how much of an enrollee's total health care costs plans must cover, but to give states more flexibility over which specific benefits plans cover. Leavitt said he and Alexander discussed the idea before the hearing.

  • Currently, it's difficult for states to get around the ACA's essential health benefits, which mandate which benefits — like mental health care or maternity coverage — plans must offer.

"What we're suggesting here is rather than try to lay out 11 different categories, where everyone is exactly the same, the states have the flexibility to have actuaries determine if their benefit package is of equal value to those essential benefits," Leavitt told me after the hearing.

The concern: Doing this could lead to adverse selection if, for example, maternity coverage is no longer mandatory and only pregnant women choose plans that offer maternity coverage.

Other ideas floated at today's hearing included changing the rules governing how much of enrollee's health care costs must be covered; and giving states more flexibility surrounding cost-sharing.

The other big issue: How long to fund the ACA"s cost-sharing subsidies. Democrats are pushing for longer than a one-year extension, although Republicans outside the committee are largely loathe to fund them at all.

Go deeper

Updated 3 hours ago - World

North Korea claims latest missile test new weapon launched from submarine

North Korean state media claims the country's military fired this missile on Tuesday. Photo: Korean Central News Agency

North Korean state media announced that a detected ballistic missile launch off its east coast on Tuesday was a newly developed weapon test-fired from a submarine.

Why it matters: Pyongyang's latest in a series of recent missile launches into the sea happened hours after U.S. officials emphasized their commitment to restart negotiations on North Korea's nuclear weapons program, which have stalled since talks broke down during the Trump administration, AP notes.

5 hours ago - Politics & Policy

Manchin's massive means test

Illustration: Aïda Amer/Axios

Sen. Joe Manchin (D-W.Va.) is offering progressives a trade: He'll vote for their cherished social programs if they accept strict income caps for the recipients, people familiar with the matter tell Axios.

Why it matters: Manchin’s plan to use so-called means-testing for everything from paid family medical leave to elder and disabled care would drastically shrink the size and scope of the programs. It also would bring a key moderate vote to the progressive cause.

The China whisperer

Nick Burns. Photo: Chen Mengtong/China News Service via Getty Images

President Biden's nominee for ambassador to China will face aggressive questioning Wednesday about the most important, and potentially perilous, bilateral relationship in the world.

Why it matters: While Nick Burns is an experienced diplomat with support on both sides of the aisle, lawmakers want to use his confirmation hearing to force the administration into some tough positions on China.