Alexander Outlines His Health Care 'Rescue Plan'
Republicans should take steps by March 1 to start work on relaxing health care overhaul rules requiring insurers to offer broad benefits, the chairman of the Senate Health, Education, Labor and Pensions Committee said Tuesday.
Tennessee Republican Lamar Alexander, who oversees one of the four committees that will lead the effort to repeal and replace the health care law (PL 111-148, PL 111-152), described what he called a “rescue plan” in a floor speech. Republican leaders, including Vice President-elect Mike Pence, have said the incoming Trump administration would pursue executive action to make some changes to Obamacare. Alexander's comments are the most detailed remarks from a chairman so far about what some of those regulatory changes could entail.
He said steps would need to be taken before March to prevent more insurance companies from exiting state exchanges by giving states more flexibility to determine 10 categories of essential health benefits that insurers are required to provide under the law. Those categories include hospital care, prescription drugs, mental health care, maternity care, emergency services and outpatient care.
Part of that plan would be executive action to modify regulations on essential health benefits, which Alexander described to reporters after his speech as “the single most important step that could be taken to create a market where more insurers are more likely to sell policies.”
If Rep. Tom Price, the Georgia Republican whom President-elect Donald Trump has chosen to lead the Department of Health and Human Services, is confirmed, he could let states change their Medicaid programs by approving waivers under that program that allow them to experiment with how their systems provide care.
Price also could use a new waiver — available under the law for the first time this year — to allow states to bypass rules if the care is at least as comprehensive and affordable as under Obamacare regulations, covers a comparable number of people, and doesn’t increase the federal deficit.
"When the new administration rewrites the guidance on Obamacare section 1332 state innovations waivers to allow for more state flexibility, states will have the authority to further innovate to build more modern health systems," Alexander said.
He also called for using executive actions to adjust special enrollment periods outside the normal sign-up period, a policy change insurers have been craving.
Alexander also said the employer mandate penalty should be repealed immediately.
He said he hoped that other parts of his plan — such as allowing individuals to use existing Obamacare subsidies to buy state-approved insurance outside of the exchanges — could be done through the reconciliation bill.
He also advocated for a temporary continuation of cost-sharing subsidies for deductibles and co-pays for the lowest-income people in the exchanges, although the House has sued the Obama administration in an effort to block those.
It's not entirely certain which of these proposals could be included in the reconciliation bill, but Alexander told reporters that "I’d like to get as much replace into the repeal bill as possible." House Speaker Paul D. Ryan said Tuesday he would like to do the same, but Senate Finance Chairman Orrin G. Hatch, who with Alexander will write the Senate's repeal and replace legislation, told reporters that he believed it would be "very difficult" to include replacement language in a reconciliation bill because of Senate rules.
Beyond any short-term fixes, however, Alexander urged caution. In his floor speech he said different parts of the health care law should be repealed “only when there are concrete, practical steps and reforms in place that give Americans access to truly affordable health care.”
Among his other proposals, he suggested expanding tax-preferred health savings accounts and providing tax credits for lower-income Americans. He said that Congress should “repeal the individual mandate when new insurance market rules are in place." He acknowledged that it might take years for some of the new insurance regulations to be implemented.
“You wouldn’t repeal a Medicaid provision, that affected someone’s Medicaid, until a state told you it had a concrete, practical alternative in place,” he told reporters.
Alexander told reporters he was speaking for himself in his speech, and that he's talked to an increasing number of senators who "see the importance of having a pretty good idea of what replacement looks like as we repeal parts of Obamacare."
However, Budget Chairman Michael B. Enzi of Wyoming took to the floor immediately after Alexander to suggest that his colleague's speech was a good road map for what could happen. “There shouldn’t be much doubt about what we’re going to try to do, and you heard it from the chairman of the HELP committee. He’s the one who will be in charge of the health aspects of this,” he said.