Here is the text of the Bipartisan Health Care Stabilization Act, co-sponsored by Senators Patty Murray (D-WA) and Lamar Alexander (R-TN), that would appropriate funding for cost sharing reduction (CSR) reimbursement payments to health insurance plans participating in the health insurance exchanges established under the Affordable Care Act (ACA). A federal district court had agreed with House Republicans in May 2016 that the payments had to be appropriated each fiscal year and a federal appeals court has been waiting for the Trump administration to formally reverse its position in the litigation since the Obama administration had defended the legality of continuing to make the payments without annual appropriations. On October 12, the Trump administration finally announced that reversal in legal position and that it would no longer make those payments, effective immediately. California, 17 other states, and the District of Columbia have requested a federal court injunction to continue the payments.
The Murray-Alexander bill is also sponsored by Senators Tammy Baldwin (D-WI), Richard Burr (R-NC), Tom Carper (D-DE), Bill Cassidy (R-LA), Susan Collins (R-ME), Bob Corker (R-TN), Joe Donnelly (D-IN), Joni Ernst (R-IA), Al Franken (D-MN), Lindsey Graham (R-SC), Charles Grassley (R-IA), Maggie Hassan (D-NH), Heidi Heitkamp (D-ND), Johnny Isakson (R-GA), Angus King (I-ME), Amy Klobuchar (D-MN), Joe Manchin (D-WV), John McCain (R-AZ), Claire McCaskill (D-MO), Lisa Murkowski (R-AK), Mike Rounds (R-SD), and Jeanne Shaheen (D-NH).
The bill would provide funding for the CSR payments through 2019 , and states accessing the payments would be required to certify that both health care consumers and the federal government are financially benefiting from the payments of the CSRs that are made to health insurance plans participating in the ACA health insurance marketplaces, to avoid the criticism that the payments are “bailouts” to the health plans. Most health economists agree that the CSRs keep more Americans insured by making health insurance more affordable, which expands the overall risk pool of insured, which allows the health plans to keep premiums and cost-sharing lower. Conversely, without the CSRs, more Americans would become uninsured because they could not afford the premiums and cost-sharing, with shrinks the risk pool, which results in higher premiums and cost-sharing for the remaining insured, and more Americans needing the ACA tax credits to pay for those higher premiums (which results in a net increase in federal spending rather than any savings).
In a direct legislative override of President Donald Trump’s executive actions, the bill also would require that the Department of Health and Human Services (HHS) engage in outreach and education activities to support enrollment in the ACA’s health insurance marketplaces, and to report back to Congress about those activities. The Trump administration is reducing the amount spent on these outreach activities by 90% when the fifth, much shortened, open enrollment period (for health plan coverage year 2018) begins on November 1 (and ends on December 15), with the federal website unavailable for 12 hours every Sunday evening, when many applicants would ordinarily be using the website.
The bill also would make numerous amendments to section 1332 of the ACA, which allows “waivers” to states to implement alternate health insurance rules, as long as levels of coverage and affordability are maintained. The amendments would provide more flexibility than the original ACA (for example, to use a ten-year period to show cost neutrality rather than having to demonstrate cost neutrality every year) and would streamline and expedite the review, approval, renewal of such waivers.
The bill also would expand the availability of so-called “copper” level, or catastrophic coverage plans with lower premiums (since they provide only catastrophic coverage), and would instruct HHS to issue regulations about selling health insurance products “across state lines”, a favorite proposal of many Republicans (that ironically, almost all national, regional, and state health plans have never requested, or supported).
The bill does not reference any specific sources of federal revenues for the CSR payments; presumably since section 1332 waivers would still have to be cost-neutral, there would be no additional costs from expanding the number or types of those waivers.
The Senate Health, Education, Labor, and Pensions Committee has prepared this section-by-section summary of the bill:
A vote on the bill has yet to be scheduled in the Senate.