Maine Senator Susan Collins Credit: CNN
Insurers hoping for stability for the individual health insurance market through legislation pushed by Republican Maine Senator Susan Collins will have to wait until the new year for such a Christmas gift.
While insurers may score a win in the $1.5 trillion tax cut that lowers the corporate tax rate from 35 to 21 percent, the bill ends the individual mandate in the Affordable Care Act. Starting in 2019, consumers will no longer be required to buy coverage. This means healthy consumers may drop their ACA insurance while those remaining in the market would likely have chronic or other costly conditions.
The result is expected to yield premium increases that will trigger a death spiral for the ACA.
After Wednesday's vote, President Donald Trump reportedly said, "We have essentially repealed Obamacare."
Republican efforts this year to repeal the ACA failed to gain traction. Collins was among those who went against her party in voting against legislation ending the ACA.
She agreed to approve the GOP tax reform bill on assurances from Senate Majority Leader Mitch McConnell that proposals to stabilize the individual market through reinsurance and cost-sharing reduction payments would be addressed in an end-of-year spending bill needed to avoid a government shutdown.
But their agreement did not have the support of all Republicans.
"Rather than considering a broad year-end funding agreement as we expected, it has become clear that Congress will only be able to pass another short-term extension to prevent a government shutdown and to continue a few essential programs," Collins and Senator Lamar Alexander of Tennessee said in a joint statement released Wednesday. "For this reason, we have asked Senator McConnell not to offer this week our legislation which independent analysts Avalere and Oliver-Wyman say would reduce premiums by about 20 percent for the 9 million Americans who have no government subsidies to help them buy insurance in the individual market. Instead, we will offer it after the first of the year when the Senate will consider the omnibus spending bill, the Children's Health Insurance Program reauthorization, funding for Community Health Centers, and other legislation that was to have been enacted this week."
Collins has taken heat on allegations she was "duped".
Alexander and Senator Patty Murray, a Democrat from Washington State, proposed bipartisan legislation to fund cost-sharing payments to insurers and to give states more authority to reduce rates.
Insurers use CSR funds to help lower deductible and out-of-pocket costs for lower-income ACA members. Trump ended the payments this year.
The Alexander-Murray bill was introduced by 24 senators, half Democrats and half Republicans.
The Collins-Nelson plan, co-sponsored with Democratic Florida Senator Bill Nelson, would provide $4.5 billion in federal reinsurance funding over 2018 and 2019 to help lower premiums by providing payments to insurers to enroll higher-cost individuals.
Trump and McConnell support these bipartisan bills, according to Collins' statement. And House Republicans voted for similar proposals earlier this year in their repeal and replace bill.
To succeed, both bills must get bipartisan support as 60 votes are needed for passage, instead of the simple majority needed to approve tax reform.
House Speaker Paul Ryan said the House remains committed to passing legislation to provide for high-risk pools and other reinsurance mechanisms, according to Collins.
In a December 9 report, according to Collins, Oliver Wyman said of the package, "We estimate that with $5 billion in funding, states collectively could provide more than $15 billion in reinsurance coverage."
This, combined with the CSR funding, would result in another 700,000 people with coverage in the individual market and a 20 percent reduction in premiums.
On December 6, Avalere said, "In combination, CSR funding and $5 billion in annual reinsurance could lower 2019 premiums by 18 percent and increase enrollment by 1.3 million people."
"There is every reason to believe that these important provisions can and will be delivered as part of a bipartisan agreement," Collins said. "And Majority Leader McConnell has told us that he will uphold his commitment to schedule and support the legislation."