Home Affordable Care Act U.S. Senate Committee Hears More Support for CSR Payments and Flexibility for States

U.S. Senate Committee Hears More Support for CSR Payments and Flexibility for States

4 minute read
by Robert Sheen

The U.S. Senate Committee on Health, Education, Labor and Pensions continued its hearings on healthcare policy yesterday. The hearing brought testimony in support of providing states more flexibility in addressing healthcare issues and continuation of cost-sharing reduction (CSR) to help insurance companies offer lower premiums and deductibles on the government healthcare exchanges.

Michael Leavitt, former Utah Governor and U.S. Secretary of Health and Human Services, urged the committee to adopt the strategy of “National Standards, State Solutions.” He said Section 1332 of the Affordable Care Act (ACA) already permits states to apply for State Innovation Waivers to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA. He urged the federal government to clarify that interdependent waivers can be evaluated based on the merit of their singular strategy.

“Alaska’s 1332 waiver is a great example of this principle in action—Alaska’s state established reinsurance program is a success story in reducing costs and increasing access to insurance for Alaska’s resident,” said Gov. Leavitt. “It is an approach other states could and should copy and improve.”

He also supported continuing CSR payments until 2018 or 2019 to provide insurance companies a better window for planning purposes. He added, “Insurance marketplaces are very fragile right now, and the window for fixing them is closing. At this point, no one is well served by their collapse.”

Bernard J. Tyson, Chairman and CEO, Kaiser Foundation Health Plan, Inc., and Hospitals, the integrated health system that provides care and coverage for nearly 12 million members in eight states and the District of Columbia, had this message for the committee: “We must work together to find real solutions to make high quality, affordable health care accessible to all Americans.”

He said whatever solutions were developed to address issues with the ACA must be sustainable over many years and not just a “patchwork” fix for 2018. “Funding the CSR payments on a permanent, or at least multi-year basis, is probably the single most important thing Congress can do to quickly stabilize the individual market,” he said.

Tyson also urged the committee to provide adequate federal funding for reinsurance programs. “The federal reinsurance program, designed to ensure that costs for covering claims over a certain point are paid by a fund that all insurers pay into, expired in 2017,” he said. “Congress can immediately help by establishing a federal reinsurance program, or significantly contributing to similar operations at a funding of state-level efforts.”

Allison O’Toole, Chief Executive Officer, MNsure, Minnesota’s health insurance marketplace, supported the permanent funding of CSR payments, creating a long-term, federal reinsurance program, and additional flexibility over the use of 1332 waivers.

“State innovation and experimentation will be key to identifying creative solutions that can maximize affordable coverage and manage health costs and quality,” she said. “We encourage additional flexibility for states, while also ensuring that all consumers can continue to receive comprehensive and affordable coverage and protection for pre-existing conditions.”

Tammy Tomczyk, FSA, FCA, MAAA, Senior Principal and Consulting Actuary for Oliver Wyman, also urged greater flexibility around Section 1332 waivers. “Each state is unique in terms of its demographic and socioeconomic make-up, insurance markets, Medicaid programs, and existing federal waivers,” she said. “Therefore, solutions that work best for one state may not be the most efficient or affordable solution for another. Allowing states to study and implement state-based solutions that are most effective for their local market may help in efforts to stabilize the individual markets.”

She urged the committee to be mindful of the role U.S. business plays in providing healthcare coverage as it looks to determine solutions to stabilize insurance markets. “While this hearing is focused on issues that most directly affect Americans who receive health insurance coverage via the individual market, it is important to remember the significant role US businesses – which cover nearly 61% of Americans – play in our healthcare system,” she said. “Congress should take careful consideration of how potential reforms in the individual marketplace may impact employer-sponsored healthcare coverage.”

Tarren Bragdon, CEO, The Foundation for Government Accountability, which works at the state and federal level to advance policy reforms, including reducing the cost of health coverage, communicating that Americans with pre-existing conditions need insurance policy premium relief, as well as access to individual insurance, without being segregated to plans with fewer benefits or higher premiums. She supported flexibility to the states’ policies to allow a greater continuum of health coverage, particularly for those Americans buying their own insurance on the individual market. She also supported bipartisan reforms that reduce the cost of health care.

“Increasing health care costs are harming patients, driving up insurance premiums, putting independent providers out-of-business, setting up massive health systems that will be too big to fail, and too often preventing doctors from making the best care decisions with their patients,” she said. “It is time we sent a life boat to patients and give them the right to shop, with the true price transparency and access that allows them to do so. If we want to truly lower health care costs, we must take these steps forward.”

The hearings will continue on Thursday, Sept. 14. Scheduled to testify to provide the perspective of healthcare stakeholders are: Manny Sethi, MD, President of Healthy Tennessee Orthopaedic Trauma Surgeon; Susan L. Turney, MD, Chief Executive Officer, Marshfield Clinic Health System, Inc.; Robert Ruiz-Moss, Vice President, Individual Market Segment, Anthem Inc.; Christina Postolowski, Rocky Mountain Regional Director, Young Invincibles; and Raymond G. Farmer, Director South Carolina Department of Insurance, NAIC Secretary-Treasurer.

You can watch video of the committee hearings, as well as download the testimony of those who testified on September 12, at this link.

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U.S. Senate Committee Hears More Support for CSR Payments and Flexibility for States
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U.S. Senate Committee Hears More Support for CSR Payments and Flexibility for States
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The U.S. Senate Committee on Health, Education, Labor and Pensions held its third hearing on ways to address issues with the ACA. Experts echo the call for continuing subsidy payments to insurance companies and expanding the use of State Innovation Waivers.
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First Capitol Consulting
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