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Health law session draws 31 senators

Aim is a modest, bipartisan tweak to shore up marketplaces, panel chief says

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Photographs by AP/MANUEL BALCE CENETA

Tennessee Department of Commerce and Insurance Commissioner Julie Mix McPeak (from left), Washington State Insurance Commissioner Mike Kreidler, Alaska Division of Insurance Director Lori Wing-Heier, Insurance Commissioner of Pennsylvania Theresa Miller and Oklahoma Department of Insurance Commissioner John Doak testify Wednesday during a Senate Health, Education, Labor, and Pensions Committee hearing on the individual health insurance market for 2018 on Capitol Hill.

WASHINGTON -- The chairman of the Senate Health, Education, Labor and Pensions Committee said Wednesday that he is trying to forge a modest, bipartisan plan by the end of next week to strengthen the Patient Protection and Affordable Care Act marketplaces.

As he opened the first of four hearings on the 2010 health care law, Sen. Lamar Alexander, R-Tenn., noted that, a month after Republican plans to tear apart the law imploded, 31 GOP and Democratic senators turned out Wednesday morning for a private meeting to talk about how they might arrive at a consensus. "That's a remarkable level of interest," he said.

Alexander described the outlines of what he termed a "small, limited bipartisan step on health insurance." He called for the government to promise funding through 2018 for cost-sharing payments to Affordable Care Act health plans to offset a requirement in the law that insurers lower deductibles and other out-of-pocket costs for lower-earning people.

A federal court has said Congress didn't legally provide the money for the payments, and President Donald Trump has threatened to block them, calling them a bailout.

Alexander also contended that the government should allow states extra flexibility to deviate from a variety of Affordable Care Act rules, including the benefits that plans sold through marketplaces must include.

Alexander acknowledged that each party "may be reluctant to support" certain elements but added, "This is a compromise we ought to be able to accept. ... If we don't, millions of Americans will be hurt."

The committee's top Democrat, Sen. Patty Murray of Washington, agreed that senators "have a very narrow window" to forge an agreement before Sept. 27, when the government requires insurers participating in the marketplaces to sign contracts for the coming year.

But Murray took a less conciliatory tone than the chairman, saying that "threading this needle will not be easy" and accusing the Trump administration of sabotage of the health care law -- most recently last week, when officials slashed federal funding of outreach activities and sign-up assistance for the Affordable Care Act's fifth enrollment season, which starts Nov. 1.

Sen. Elizabeth Warren, D-Mass., echoed Murray's concerns of sabotage, citing, among other things, Trump's threats to end the cost-sharing payments to insurers. Trump's effort is "petty, and it's going to hurt millions of people," she said.

Murray also made clear the Democrats' differences with the GOP over even limited efforts to stabilize the insurance marketplaces. Murray said the government should promise insurers cost-sharing payments for multiple years and should re-create a "reinsurance" fund that existed during the law's first three years to buffer insurers from the expense of customers with especially high medical costs.

Still, Alexander said after the meeting, "I think we did a pretty good job today of not blaming each other." Murray, too, said later that she was "very hopeful" that the two sides could reach agreement on a measure.

Regardless of the future of the latest negotiations, the hearings this week and next mark the closest collaboration between Republicans and Democrats in years on an issue that has defined their ideological differences.

Wednesday's session featured five state insurance commissioners who were invited to provide a ground-level view of ways that the marketplaces in their states have become shakier and to offer suggestions about shoring them up.

Julie McPeak, commissioner of the Tennessee Department of Commerce and Insurance and the incoming head of the National Association of Insurance Commissioners, testified that her state's marketplace had deteriorated further since she said a year ago that it was "very near collapse." She said 78 of Tennessee's 95 counties will have only one insurer selling Affordable Care Act health plans for 2018. She urged Congress to start fixing exchanges nationwide by guaranteeing payments of those cost-sharing subsidies and re-creating the federal pool of reinsurance money.

Washington's insurance commissioner, Mike Kreidler, said his state has seen a "serious jolt to the system" this year because of "the growing uncertainties and actions of the administration. Our individual insurance markets are in serious peril."

Kreidler said Congress should guarantee cost-sharing payments on a permanent basis -- longer than even Murray is urging. He also said lawmakers should leave in place the government's rules spelling out the benefits that Affordable Care Act health plans must cover.

Information for this article was contributed by Amy Goldstein and Juliet Eilperin of The Washington Post; and by Alan Fram of The Associated Press.

A Section on 09/07/2017

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