After holding four hearings with healthcare stakeholders, Republican Sen. Lamar Alexander, chairman of the Health Education Labor and Pensions Committee, said he would work with other Senators to come to a consensus on a bill for a full vote by the end of the month.
The bipartisan bill will not do away with the Affordable Care Act but is expected to recommend at least two big changes, extending cost-sharing reduction payments and giving states more plan design flexibility in Section 1332 innovation waivers.
Republicans won't like funding the CSRs and Democrats will oppose giving states more flexibility, Alexander said. But he can't offer a bill to extend CSRs without giving states more flexibility, he said.
"If we do that, I'm convinced we can limit the increase in premiums in the year 2018," Alexander said. "And put in place some improved flexibility for states that will mean lower premiums in the future."
The waiver flexibility would reduce the six month review period and would allow for changes in one state to be transferable to another state without the extended review period.
The bill may also include a reference to actuarial equivalence for states. This would mandates that plans with varying level of benefits have similar value of plans on ACA market.
Also, there is consensus for expanding the availability of a copper plan that's already in law, Alexander said. It won't be those consumers who are 29 and younger who can purchase a copper plan, he said.
Individuals 26 and younger would be able to remain on their parents' insurance, as they can now under the ACA.
The individual and employer mandates in the ACA are in question.
Alexander said Thursday that after getting consensus from members of the committee and other Senators, he would ask Senate Majority Leader Mitch McConnell and Minority Leader Chuck Schumer to send the bill to the full Senate for a vote.
If the bill doesn't go through, in 2016, 36 percent of ACA consumers will have a choice of one insurer on the exchange, Alexander said.
Also, insurers are on a Sept. 27 deadline for their exchange market premium rates to be posted on Healthcare.gov. Open enrollment starts November 1.
Insurers who have spoken over the course of two weeks have advocated for CSRs, reinstatement of the reinsurance program and a continued moratorium on the health insurance tax.
Susan Turney, CEO of Marshfield Clinic Health System in Wisconsin, said CSR payments are no bailout to insurance companies.
"The CSR payments are simply a pass-through payment to providers, with no financial benefit to health insurers," Turney said. "Health insurers are simply the mechanism by which these payments are made to providers on behalf of members who receive these subsidies."
She recommended continued funding to health insurance carriers for 2018 and beyond and to allow states that have already reached their filing deadline to reopen carrier's bids to allow for an adjustment to rates.
Turney advocated to enhance the risk adjustment program to pay carriers a capitation for members whose risk scores exceed a certain predefined value.
She and other providers and insurers also recommended the government reinstate navigator funding to assist consumers in enrolling.
Anthem has withdrawn from numerous ACA markets due to market instability and financial losses.
Robert Ruiz-Moss, vice president, Individual Business, at Anthem in Denver, said a stable insurance market needs a balanced risk pool. There's not enough healthy individuals are enrolling in coverage.
Some only purchase coverage to receive services and then drop that coverage, which has accelerated deterioration of the individual market risk pool. Nearly 20 percent of Anthem individual market members only maintained their coverage for six months or less in 2016, he said.
"The effects of this behavior are reflected in the average risk score of enrollees in the individual market, which Anthem data shows to be 10 percent higher than that of enrollees in the small group market in 2016, with the gap widening further so far this year," he said.
On Tuesday, Kaiser Permanente CEO Bernard Tyson said it was important to enforce the individual mandate, support outreach, repeal the health insurance tax, and to enhance state flexibility,
Existing law contains specific protections, known as guardrails to ensure waivers are consistent with the best interests of consumers, Tyson said. These guardrails of comprehensiveness, affordability, availability and deficit neutrality make sense and need to be preserved in any expanded waiver authority made available to states, he said.