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Senate health care talks focus on state innovation waivers

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.