Even as Republicans continue to insist that the repeal and replacement of the Affordable Care Act is still a legislative priority, some in the GOP recognize that President Trump’s strategy of sitting back and waiting for the healthcare system to “explode” isn’t really a viable option for the party in complete control of Washington.
On Wednesday, two Tennessee Senators, Lamar Alexander and Bob Corker, introduced legislation meant to solve one of the problems bedeviling the ACA: Many insurers throughout the country have left the health care exchanges set up by the law, leaving many consumers with just one insurance provider and thus a limited--and often more expensive--choice.
The concern now is that next year it is possible that further withdrawals from the market could leave some areas with no offerings at all on the health care exchanges. To counter that problem, the bill Alexander and Corker put forward would make it legal for people who receive health insurance subsidies under the law to spend them outside the exchanges.
Under the ACA, the exchanges were set up to create a marketplace for individuals who were not covered by employer or government-sponsored insurance to purchase plans on the non-group market. Many of those people would be eligible for considerable government support to help pay for premiums.
In exchange for access to these consumers with federal money to spend, insurers that offered plans on the exchanges were required to offer coverage that met federal guidelines covering the type of care that was covered, restrictions on costs, and more. Insurers were still allowed to sell policies outside the exchanges, but consumers were not allowed to spend federal dollars on those policies.
That restriction, in a market where no insurers were on the exchanges, would leave individuals with no options.
“There are 34,000 Knoxville area residents who rely on an Affordable Care Act subsidy to purchase insurance, and after the one remaining insurer pulled out of the exchange for 2018, these subsidies are worth as much as bus tickets in a town with no buses running,” Alexander said. “There is also a real prospect that all 230,000 Tennesseans who buy insurance on the exchange—approximately 195,000 with a subsidy—won’t have any plans to buy next year either, and millions of Americans in other states are facing the same dire circumstances.”
The bill would also waive the penalty that the law imposes on people who go without health insurance for those living in a market with no options.
In their statement announcing the bill, the two senators tried to preserve the “repeal and replace narrative”
“At some point, on behalf of the American people, Congress and the administration have to resolve the issues that are driving up healthcare costs, limiting choices, and causing the exchange market to spiral downward,” Corker said. “However, in the interim, we must take steps to ensure people in places like Knoxville, where more than 34,000 individuals receiving subsidies under current law will have zero options in 2018, have the opportunity to purchase health insurance off the exchange in the individual market.”
They even set up a sunset provision for their proposal, saying that it would expire in 2019. However, there are any number of government proposals on the books that are ostensibly temporary but wind up being, for all practical purposes, permanent law.
It’s obviously too soon to say for certain that the effort to scrap the ACA and replace it with something more to Republicans’ liking is dead. But as House Speaker Paul Ryan said last week in the wake of the implosion of his party’s proposed American Health Care Act, it is inescapably the law of the land for the foreseeable future.
Alexander and Corker may represent the first wave of Republicans acknowledging that with control of the government firmly in their hands, the political risks of allowing the health insurance system to die of neglect outweigh the benefits of appearing ideologically pure.