Led by Oregon Congressman Kurt Schrader, 10 House Democrats have floated a plan to fix Obamacare as Senate Republicans prepare to vote on a revamped alternative that still slashes Medicaid spending by $700 billion.
Schrader said the House Democratic plan proposes “real, concrete solutions that will stabilize and improve the individual market, making Obamacare work better for everyone and getting us closer to universal coverage for all Americans.”
One of the key elements in the Schrader proposal is a $15 billion annual reinsurance fund to pay health insurers that enroll higher-cost, sicker individuals. Obamacare contained a similar reinsurance fund from 2014-2016. The concept is to ease the cost burden for insurers of expensive care for some patients so average premiums for participants in the individual market can be lowered.
Other features include continuation of payments to insurers that offer discounts to low-income patients, changing the enrollment period from November to May to coincide with when taxpayers receive income tax refunds and expanding tax credits for buying insurance based on age, geography and income. The plan calls for robust marketing of health plans with subsidies and drawing bidding areas that provide more competition for underserved rural areas.
"Although we’ve made progress, Members of Congress have to acknowledge that too many Americans still struggle with costs, especially people in the individual market," Schrader said.
Schrader and his colleagues also would allow people nearing retirement age the option to buy into Medicare coverage and permit younger adults to purchase catastrophic health plans that include primary care coverage with anticipated lower premiums.
Oregon Senator Ron Wyden urged a bipartisan approach to stabilize the individual health insurance market. He also encouraged steps to lower prescription drug costs, such as allowing Medicare to negotiate drug prices with pharmaceutical companies.
The first inklings of Democratic willingness to work on cracks in Obamacare came after Senate Majority Leader Mitch McConnell indicated that if a GOP alternative fails to pass, the only avenue left is a bipartisan approach. President Trump and political conservatives have said failing to repeal and replace Obamacare would break a longstanding Republican promise. Kentucky GOP Senator Rand Paul has announced he will oppose the GOP health care bill because it doesn’t go far enough toward repealing Obamacare provisions.
Meanwhile, GOP moderates are worried about the impact of large cuts to Medicaid on elderly and disabled Americans, who consume the largest amount of Medicaid funding. In the revised version of the Senate health care bill, more money is set aside to combat the national opioid crisis in a play to win over some wavering Senate moderates, but it still might not be enough.
Maine Senator Susan Collins, one of the moderates unconvinced by the redrafted plan, pointed out there is a $70 billion math error. The Better Care Reconciliation Act includes an amendment by Texas Senator Ted Cruz that would allow bare-bones health plans also provides $70 billion in federal support for health insurers. Except the $70 billion Cruz would use for this purpose is already allocated in the bill. Tim Jost, a health care law expert and professor at Washington and Lee University, told MSNBC that the bill “gives an additional $70 billion to the states and then the Cruz amendment gives it to insurers that offer compliant plans in addition to noncompliant plans.”
Congressional Republicans are using the budget reconciliation process to replace Obamacare because this procedural is not subject to Senate filibuster rules. But the 52-member Senate GOP majority is thin and only can afford to lose two members to pass its health care legislation. Senate Minority Leader Chuck Schumer has said Democrats would work with Republicans if they dropped the reconciliation process. According to The Hill, some Republican senators, including Lindsey Graham, have entertained informal conversations with Democrats about a bipartisan legislative approach.
The GOP-backed American Health Care Act passed the House earlier this year with a narrow 2-vote margin. The changes under consideration in the Senate, including retaining two taxes imposed by Obamacare, might erode that margin and make a reconsideration vote in the House uncertain. House Minority Leader Nancy Pelosi has not offered to work with Republicans on Obamacare-related legislation. Pelosi did say the Schrader-led proposal offer “promising ideas to put solutions over politics to strengthen the Affordable Care Act and continue to lower costs for seniors and hard-working families.”