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(Alex Brandon / AP)

Lawmakers and policy experts are honing in on a small handful of policies — mostly, different forms of federal funding and regulatory flexibility — as the Senate tries its hand at a bipartisan Affordable Care Act fix.

The first of several Senate HELP Committee hearings on the individual market was (believe it or not!) full of substantive health policy discussions, as members questioned state insurance commissioners. Everyone seemed interested in funding the Affordable Care Act's cost-sharing subsidies, and most seemed interested in expanded regulatory waivers for states. A handful of other policy ideas, including direct government payments to help offset the costs of expensive patients, are also looking pretty popular.

What's happening:

Reinsurance programs — in which the government pays insurers to offset the costs of their most expensive patients — came up repeatedly. Speaking of Maine and Alaska's state reinsurance programs, GOP Sen. Susan Collins said, "I think if you look at the experience of those two states alone, it shows the benefit of reinsurance pools."

  • Julie McPeak, Tennessee's insurance commissioner, said it can be difficult for states to set up their own reinsurance programs or high risk pools, but they could be very helpful. "I see the additional benefit of the reinsurance program not only to reduce premiums for consumers, but also to increase competition" because "insurers could better estimate the risk of entering the market."
  • Democratic Sen. Al Franken also questioned the commissioners about reinsurance, leaving little doubt about how he felt about it when he asked whether "anyone else [would] like to talk about the wisdom of a permanent federal reinsurance program?"
  • The problem: "Reinsurance really hard. Costs money. We don't have any money," one senior GOP aide told me."if a reinsurance program is such a good idea and Alaska was able to set one up using some state funds…why don't states do it? All it takes is money," HELP Chairman Lamar Alexander asked.

Also back on the table, per the senior aide: Allowing people younger than 30 to buy polices that only cover catastrophic care.

  • Collins also brought this up, and commissioners seemed generally supportive of the idea.
  • The senior aide said adding a copper plan is being discussed either as part of expanded state waivers or in all markets.

There have been several conversations about changes to the ACA's state innovation waivers, particularly about speeding up the federal approval process and making them more flexible.

  • "We are proposing changing the standards on what the waiver is judged against. Does it have to be exactly like ACA or can it be different at the states request?" the senior aide said.

Go deeper

3 hours ago - Health

Fauci: Omicron variant will "inevitably" be found in U.S.

Photo: Chip Somodevilla/Getty Images

Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, cautioned on Sunday that the COVID-19 Omicron variant will "inevitably" be found in the United States.

Driving the news: Fauci, Biden's chief medical adviser, told ABC's George Stephanopoulos on "This Week" that U.S. officials will meet with colleagues from South Africa later on Sunday to try to determine the severity of the cases, as countries scramble to learn more about the variant.

Updated 5 hours ago - Politics & Policy

Dems fear supply-chain blame

Illustration: Aïda Amer/Axios

As supply-chain kinks drive up prices and disrupt holiday shopping, Democrats are scrambling to show action and deflect blame.

Why it matters: With their party controlling both the White House and Capitol, vulnerable Democrats worry supply-chain snafus will hurt them in next year's midterms.

5 hours ago - World

Scoop: Germany urges Congress not to sanction Putin’s pipeline

Photo: Mikhail Svetlov/Getty Images

The German government has urged members of Congress not to sanction the Nord Stream 2 pipeline, arguing that doing so will "weaken" U.S. credibility and "ultimately damage transatlantic unity," according to documents obtained by Axios.

Why it matters: At a time when roughly 100,000 Russian troops are massing at its border, Ukraine views Nord Stream 2 as an existential threat to its security. The pipeline would circumvent Ukrainian transit infrastructure and deliver Russian gas directly to Germany, eliminating one of the last deterrents Ukraine has against an invasion.