Congress on Recess, but Uncertainty Lingers

The Republicans have not given up on repealing Obamacare, but attention appears to be shifting to a bipartisan approach to achieve market stability. Senator Lamar Alexander, Republican of Tennessee, has pledged to work with Senator Patty Murray, Democrat of Washington, and the Senate Health Committee to convene hearings when Congress returns following Labor Day. Alexander intends to tackle the short-term needs and allow more time to tackle bigger issues. No details yet on what this might look like, aside from guaranteeing cost sharing subsidies remain in place and granting states more flexibility. A bipartisan group of policy experts echoes these goals, and recommends that states be granted wider latitude to tailor risk adjustment methodologies and explore different risk pooling designs. They also recommend that outreach and enrollment efforts continue to be funded.

While activity in Congress is slow, there’s a need to closely monitor administrative actions, which could have serious negative impacts on the Affordable Care Act (ACA). While Trump continues to talk about “letting Obamacare fail,” the weaknesses of the insurance market stem from Administration policies and delays. Still no word from the Trump administration on their potential effort to eliminate ACA cost-sharing subsidies in the Exchanges. In 2016, a federal judge ruled that Congress did not appropriate funding for the subsidies. But the subsidies remain in effect pending an appeal of the decision to a higher court. In a positive development, last week a federal court allowed the attorneys general from 17 states, including Washington, to intervene in the legal defense of the subsidies. In addition to the cost-sharing subsidies, the Administration must decide other key administrative issues, like if and how to fund outreach to potential enrollees, whether to enforce the individual mandate, and how to staff the call center. Polling shows that just 32 percent of respondents to a CBS poll approve of the way Trump is dealing with the issue of healthcare, compared to 59 percent who disapprove.

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