188:, was gaining steam. The legislative calendar at the time looked fairly full, and so it quickly became clear that passage of Alexander-Murray would have to come as part of some larger agreement. Senator Susan Collins, one of the cosponsors of the bill, had serious concerns about the tax legislation, particularly regarding the repeal of the Affordable Care Act's individual mandate in the tax bill. In order to help compensate for what she saw as poor healthcare policy, she made Senate Republican Leadership promise to pass Alexander-Murray, among other pieces of healthcare legislation. However, Majority Leader Mitch McConnell was unable to keep his promise and never passed Alexander-Murray, as of May 2018. However, Collins' vote was crucial to pass the tax bill through the Senate with the thin majority Republicans had.
128:
along with premium prices to cover the additional costs not subsidized by the CSRs. CBO also estimated that initially up to one million fewer would have health insurance coverage, although coverage may increase in the long-run as the premium subsidies increase. This initial drop would be due in part to the fact that insurers would leave some markets due to the instability and risk of unknown costs, leaving about 5 percent of people living in areas with no insurers in 2018. CBO expected the exchanges to remain fairly stable (e.g., no "death spiral") as premiums would increase and prices would stabilize at the higher (non-CSR) level.
28:
120:
82:
the actuarial value of the plans. For example, in 2016 the maximum out of pocket for an individual on a silver plan was $ 6,850, but for individuals with an income up to 200 percent of the FPL, that maximum cost was reduced to $ 2,250. Simultaneously, these CSR payments were able to increase the actuarial value of a silver plan from 70 percent to 87 percent for those with incomes between 150 and 200 percent of the poverty line. 56 percent of all marketplace enrollees were receiving CSRs as of 2015.
132:
who do not receive subsidies face the brunt of the 20%+ premium increases, without subsidy assistance. This may adversely impact enrollment in 2018 and beyond. Another 13 million who are now covered under the ACA's
Medicaid expansion (in the 31 states that chose to expand coverage) should not be directly affected by the President's action.
175:
policy changes in the legislation to already included the CSR payments that were being returned in the
Alexander-Murray bill. The expanded state waiver flexibility would result in increased costs, but this would be brought down by the restoration of CSR payments as well as the addition of "copper" tier plans.
106:
On
October 12, 2017, after months of speculation, the Trump Administration announced that they were discontinuing the cost sharing reduction payments, claiming that the payments were unconstitutionally circumventing the legislative appropriations process. This was among the actions taken by President
85:
Premium tax credits are the other main subsidy in the ACA, representing a much larger portion of ACA spending, and they were designed to reduce the post-subsidy cost of monthly premiums, apply to all enrollees earning less than 400% of the FPL. For scale, during 2017, approximately $ 7 billion in CSR
81:
The CSR subsidies are paid to insurance companies to reduce copayments and deductibles for a smaller group of ACA enrollees, those earning less than 250% of the federal poverty line (FPL). They are meant to reduce the cost for enrollees in this income bracket that are on silver plans while increasing
140:
Although the Trump
Administration did not officially cancel the CSR payments until mid-October 2017, he had been talking about doing so long before, and so there were already ongoing negotiations between Senator Lamar Alexander (R-TN) and Senator Patty Murray (D-WA), the Chair and Ranking Member of
131:
CBO estimated that of the 12 million with private insurance via the ACA exchanges in 2017, about 10 million receive premium tax credit subsidies and will be shielded from premium increases, as their after-subsidy premiums are limited as a percentage of income under the ACA. However, those 2 million
127:
The CBO reported in August 2017 (prior to
President Trump's decision) that ending the CSR payments would increase ACA premiums by about 20 percentage points in 2018, with a resulting increase of nearly $ 200 billion in the budget deficit over a decade, as the premium tax credit subsidies would rise
145:
failed, these negotiations quickly restarted again. Eventually, Alexander and Murray did reach an agreement on the outline of a plan. The bill included funding of CSR payments for two years, as well as additional funding to help marketing of the enrollment period for the ACA. It made it easier for
174:
The CBO reported on 25 October 2017 that the bill would end up cutting the deficit by $ 3.8 billion. While the CBO estimate of the bill did not expect it to substantially change the number of people on health insurance on net, this was mostly because the CBO baseline that they were comparing the
93:
argued that the premium tax credits and the cost sharing reductions were "economically and programmatically integrated" in the
Affordable Care Act, and so the appropriation that covers the premium tax credits also allowed HHS to pay CSR payments. However, the House of Representatives sued the
63:. The plan will also provide more flexibility for state waivers, allow a new "Copper Plan" or catastrophic coverage for those under 30, allow interstate insurance compacts, and redirect consumer fees to states for outreach. President Trump had stopped paying the cost sharing subsidies and the
111:. Trump had received warnings against this move from members of both parties, including one Republican senator who told him that the Republican Party would effectively “own health care” as a political issue if the president cancelled the CSR payments, but he moved forward with it anyway.
141:
the Senate Health, Education, Labor and
Pensions Committee, to try to find a bipartisan solution to the looming problem. These negotiations had to be put on hold for much of September 2017 as Republicans made one last attempt to repeal and replace the Affordable Care Act, but when the
98:, was that CSRs required a specific appropriation, but stayed any cancellation of CSR payments if and when appeals to the decision were made. The arguments made in this case became the backdrop for why the Trump Administration would cancel these payments.
667:
44:
154:, and also allowed for people under 30 to purchase catastrophic health insurance plans, often called 'copper' plans for their low actuarial value. The bill quickly received 24 bipartisan cosponsors, including Sen.
183:
The timing of the
Alexander-Murray agreement had a major role in the difficult path to passage for the bill, as the deal was announced just as the Republican push for tax reform, which would soon become the
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Administration over this, arguing that the lack of an explicit appropriation for CSRs means that the payments can not be made. The decision in this case,
56:
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estimated his action would cost $ 200 billion, cause insurance sold on the exchange to cost 20% more and cause one million people to lose insurance.
142:
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166:(D-WV). However, the bill faced a murky political future due to opposition from Republican leadership in both chambers of Congress.
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280:
CBO-Federal
Subsidies for Health Insurance Coverage for People Under Age 65: 2017 to 2027-September 14, 2017
251:
904:
676:
123:
CBO projected impacts of cancellation of CSR payments on the federal deficit and health insurance coverage
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292:"Trump Administration Takes Action to Abide by the Law and Constitution, Discontinue CSR Payments"
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864:
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637:
89:
Under the Obama administration, these cost sharing reduction payments were paid out because the
784:
325:
860:
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395:"Alexander, Murray strike bipartisan Obamacare deal providing subsidies, state flexibility"
894:
688:
48:
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714:
550:
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820:
224:"CBO says Trump's Obamacare sabotage would cost $ 194 billion, drive up premiums 20%"
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890:
880:
874:
354:
CBO-The
Effects of Terminating Payments for Cost-Sharing Reductions-August 15, 2017
52:
750:
163:
524:"Collins lets McConnell slide on promise to shore up insurance markets in 2017"
850:
730:
329:
830:
252:"Judge Rules Against Administration In Cost-Sharing Reduction Payment Case"
419:"Alexander and Murray announce 24 co-sponsors of bipartisan Obamacare fix"
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subsidies will be paid, versus $ 34 billion for the premium tax credits.
988:
810:
800:
790:
740:
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499:"Key senators sold their votes on the tax bill for some high-risk deals"
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318:"Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again"
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31:
CBO report on the Bipartisan Health Care Stabilization Act of 2017
26:
546:
206:"2 Senators Strike Deal on Health Subsidies That Trump Cut Off"
367:"Alexander, Murray inching toward deal to stabilize Obamacare"
602:
Provisions of the Patient Protection and Affordable Care Act
365:
Haberkorn, Jennifer; Everett, Burgess (September 28, 2017).
316:
Pear, Robert; Haberman, Maggie; Abelson, Reed (2017-10-12).
648:
Authority for Mandate Delay Act (H.R. 2667; 113th Congress)
107:
Trump to start to dismantle the Affordable Care Act after
441:"CBO: Alexander-Murray Healthcare Bill Could Save $ 3.8B"
1030:
Proposed legislation of the 115th United States Congress
43:) was a 2017 proposed compromise reached by senator and
696:
National Federation of Independent Business v. Sebelius
18:
Murray—Alexander Individual Market Stabilization Bill
596:
Health Care and Education Reconciliation Act of 2010
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Role of Alexander-Murray in broader political debate
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936:
924:
705:
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466:"Bipartisan Health Care Stabilization Act of 2017"
150:, without allowing states to circumvent the ACA's
109:Congress had failed to repeal it earlier in 2017
37:Bipartisan Health Care Stabilization Act of 2017
953:America's Affordable Health Choices Act of 2009
275:
273:
204:Thomas Kaplan; Robert Pear (17 October 2017).
51:and senator and HELP Committee ranking member
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471:. Congressional Budget Office. Archived from
115:CBO estimate of impact of ending CSR payments
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658:Patient-Centered Outcomes Research Institute
592:Patient Protection and Affordable Care Act
588:Patient Protection and Affordable Care Act
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551:
543:
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347:
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162:(R-AK), Sen. Joe Donnelly (D-IN) and Sen.
393:Haberkorn, Jennifer (October 17, 2017).
984:Health care reform in the United States
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91:Department of Health and Human Services
948:Affordable Health Care for America Act
136:Alexander-Murray negotiations and bill
653:Contraceptive mandate (United States)
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855:New Mexico Health Insurance Exchange
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386:
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102:Trump Administration actions on CSRs
96:House of Representatives v. Burwell
497:Nilsen, Ella (December 20, 2017).
439:Beaton, Thomas (26 October 2017).
25:
795:Illinois Health Benefits Exchange
264:10.1377/forefront.20160512.054852
61:cost-sharing reductions subsidies
643:Physician Payments Sunshine Act
77:Cost sharing reductions subsidy
250:Jost, Timothy (May 12, 2016).
1:
707:Health insurance marketplaces
186:Tax Cuts and Jobs Act of 2017
958:America's Healthy Future Act
607:Health insurance marketplace
915:Washington Healthplanfinder
745:Connect for Health Colorado
522:Swanson, Ian (2017-12-20).
445:HealthPayerIntelligence.com
65:Congressional Budget Office
39:(colloquially known as the
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1025:Presidency of Donald Trump
925:Federal insurance exchange
825:Health Insurance Connector
815:Maryland Health Connection
717:, an option for all states
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725:Arkansas Health Connector
668:Constitutional challenges
633:Essential health benefits
152:essential health benefits
256:Health Affairs Forefront
940:from the 111th Congress
775:Hawaii Health Connector
938:Other reform proposals
905:Vermont Health Connect
677:Burwell v. Hobby Lobby
612:Contraceptives mandate
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963:Healthy Americans Act
617:Executive Order 13535
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41:Alexander-Murray bill
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968:Medicare for All Act
170:CBO estimate on bill
1020:Affordable Care Act
574:Affordable Care Act
143:Graham-Cassidy bill
57:Affordable Care Act
865:NY State of Health
845:Nevada Health Link
735:Covered California
638:Premium tax credit
478:on 25 October 2017
421:. October 19, 2017
322:The New York Times
210:The New York Times
146:states to receive
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785:Your Health Idaho
683:Coons v. Geithner
16:(Redirected from
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875:Cover Oregon
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581:Key articles
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298:. 2017-10-12
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148:1332 waivers
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53:Patty Murray
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164:Joe Manchin
1014:Categories
626:Provisions
533:2018-03-07
508:2018-03-07
482:26 October
450:26 October
425:2018-03-07
404:2018-03-07
376:2018-03-07
335:2018-03-05
302:2018-03-05
233:2017-10-17
192:References
71:Background
330:0362-4331
47:chairman
994:Medicare
989:Medicaid
977:See also
399:POLITICO
371:POLITICO
59:to fund
528:TheHill
296:HHS.gov
885:Pennie
835:MNsure
805:Kynect
328:
999:SCHIP
476:(PDF)
469:(PDF)
594:and
484:2017
452:2017
326:ISSN
35:The
503:Vox
260:doi
228:Vox
1016::
911:WA
901:VT
891:RI
881:PA
871:OR
861:NY
851:NM
841:NV
831:MN
821:MA
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791:IL
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771:HI
761:DC
751:CT
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731:CA
721:AR
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Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
