Advocates Push Passage of Health Deal as Open Enrollment Nears

CBO says it’s too late for lower premiums next year, but hopes for ’19 remain

Chairman Sen. Lamar Alexander arrives for a Senate Health, Education, Labor and Pensions Committee hearing on Sept. 19. (Bill Clark/CQ Roll Call file photo)
Chairman Sen. Lamar Alexander arrives for a Senate Health, Education, Labor and Pensions Committee hearing on Sept. 19. (Bill Clark/CQ Roll Call file photo)
Posted October 26, 2017 at 5:00am

Democrats concerned about the confusion surrounding individual health insurance are urging a vote on bipartisan legislation to stabilize the marketplaces as a sign-up period next week creeps closer.

Still, it appears increasingly likely that lawmakers won’t consider such a proposal until closer to the end of the year. And many experts say the bill’s impact for 2018 would be modest anyway.

“This needs to be done urgently,” said Sen. Patty Murray of Washington, the lead Democratic supporter of the measure. “And people need to know an answer.”

But it’s practically certain that it won’t become law before open enrollment begins next Wednesday. Senate Health, Education, Labor and Pensions Chairman Lamar Alexander of Tennessee has said a bill similar to the draft he unveiled last week with Murray could pass by the end of the year. That could involve tying the measure to a year-end spending deal or another must-pass package. President Donald Trump has sent mixed signals about whether he would sign the Alexander-Murray measure.

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While waiting isn’t ideal, no one is saying it’s a deal breaker.

Lawmakers acknowledge that it is too late for a stabilization measure to bring down premiums in many states for the 2018 coverage year, but point to hopes for stability in 2019. Most insurers finalized their rates before any legislation was introduced and before the Trump administration stopped reimbursing insurers for the health care law’s cost-sharing payments. Many set increases, expecting the subsidies would end.

The Congressional Budget Office confirmed that on Wednesday. The CBO also said if the Alexander-Murray bill passed, states would need to set up some type of rebate program under the bill to reimburse consumers and the federal government in places that set higher premiums amid the uncertainty of whether the subsidies would be paid. It’s unclear how exactly states would handle those programs.

One time-sensitive piece of the bill is nearly $106 million for outreach and enrollment for coverage in 2018 and 2019. The open enrollment period for coverage in 2018 begins Nov. 1 and stretches until Dec. 15.

Advocates say additional outreach money is critical, after the Trump administration slashed advertising funding from $100 million last year to $10 million this year. Supporters expect great confusion around this year’s sign-up period based on the Republican effort to dismantle the 2010 health care law over the past year.

[CBO: Alexander Murphy Would Reduce Deficit by $3.8B]

“It makes it much harder to affect this year’s rates if this falls to December,” said Sen. Christopher S. Murphy, a Connecticut Democrat. “And the marketing and advertising money is pointless if it’s in December. The effectiveness of this is greatly compromised if we lose October and November.”

While advocates want that money to be effective during this year’s sign-up period, they say it can still be useful afterward and is important for 2019.

“While more money and resources would be welcome, it’s really late in the game for that to make a real profound difference in the next open enrollment period,” said Liz Hagan, associate director of policy at the National Association of Health Access Assisters. “But Alexander-Murray would seemingly have that money moving forward included as well.”

There is a “small window” for the measure to affect 2018 coverage, said Lori Lodes, a co-founder of Get America Covered, a group aimed at signing people up founded by two former Health and Human Services officials during the Obama administration.

Even if the additional advertising money were available before the end of the sign-up period, it would be a last-minute purchase and therefore more expensive, Lodes said.

“It’s hard to see how the money could be used this year in a way that it would be as effective as it would be if they had not taken the money away in the first place,” she said.

Additionally, many navigators, who assist consumers in signing up for health care coverage, have already had to restructure their staffs and budgets in light of an administration decision to cut their funding by 41 percent compared to last year.

Navigators work year-round to help people understand how to use their coverage, so the funding would still be used, Lodes said. Each year, some people don’t pay their premiums and therefore don’t maintain their coverage.

Additionally, the Centers for Medicare & Medicaid Services will not notify consumers if they are being automatically re-enrolled in their plans until after the sign-up period ends, a change from past years. That sparks concerns that those consumers could be surprised by higher premiums and not maintain coverage, said Stan Dorn, a senior fellow at Families USA. Navigators could help those people.

“In an ideal world, we would see this problem solved immediately,” he said. “If it doesn’t get fixed until after enrollment begins, it’s still very important that the problem be solved as quickly as possible.”