- The Washington Times - Sunday, May 21, 2017

With Obamacare still the law of the land, Republicans and Democrats are searching for quick fixes that will help Americans who live in parts of the country that insurers have forsaken, saying they just can’t make money under the strictures of the 2010 health care law.

The two Tennessee Republicans in the U.S. Senate, Bob Corker and Lamar Alexander, are pushing a plan to let customers left without any options on Obamacare’s exchanges take their taxpayer-funded subsidies outside the exchanges and buy any plan approved for sale in the state’s individual market.

Meanwhile, Sen. Claire McCaskill, Missouri Democrat, wants people left without plans back home to be able to buy coverage on the exchange in the District of Columbia, giving them access to the same plans available to members of Congress.

“I’m not interested in just throwing stones; I’m ready to work with anyone to improve health care for Missourians,” said Ms. McCaskill, a centrist who faces re-election next year in a state that Donald Trump carried by nearly 20 percentage points in November.

It’s a slimmed-down version of a solution Republicans have been pushing for years: letting Americans buy plans from other states as a way to lower costs through more competition.

While the Republican repeal effort slowly chugs along, all sides are hoping to create some certainty for insurers, which must decide by late June whether to offer plans on the exchanges for next year.

Customers are also looking for assurances, facing another year of double-digit premium hikes as insurance companies face the increasingly poor economics of Obamacare, coupled with major questions about how much the Trump administration will prop up the troubled law.

Even if the Republican repeal effort is successful, current plans call for parts of Obamacare to remain in effect through 2020.

“There will have to be a transition process, and it will be over several years,” Sen. James Lankford, Oklahoma Republican, said in a recent floor speech.

That puts pressure on lawmakers to figure out immediate fixes.

In Iowa, much of the state could have zero options in the individual market if one more insurer decides to bail, while Tennessee is trying to fill a void left in Knoxville by Humana’s decision to fully withdraw from the Obamacare markets next year.

Sen. Ron Johnson, Wisconsin Republican, told reporters last week that Senate Republicans are mulling whether to push measures that buttress the individual market in the short term, alongside a broader debate over an Obamacare replacement bill that squeaked through the House this month.

Senators are still trying to decide whether to tweak the Republican plan, perhaps by bolstering tax credits for poorer and older Americans or by preserving part of the 2010 law’s vast expansion of Medicaid coverage.

A 13-member Republican working group hasn’t announced any proposals, though Ms. McCaskill stepped in from the left with her D.C. solution, noting the capital’s exchange already serves Capitol Hill lawmakers and staff who are required to use Obamacare’s exchanges.

Mila Kofman, executive director of the D.C. exchange, said it is flattering that a member of Congress sees its portal as a useful tool. Her staff is working with Ms. McCaskill on whether the plan is feasible.

“We can definitely be part of the solution to what they need from a technical perspective, but in terms of serving the nation, we would need to see the final details, essentially,” she said.

Ms. Kofman said her exchange would balk at any plan that drives up costs for D.C. residents or businesses. Using the District as a fallback might be costlier than usual — insurers in their home states retreated for a reason — while higher reimbursement rates for doctors in other states could affect premiums in the nation’s capital.

“If these concerns are not addressed, we’ll try to work with Sen. McCaskill’s staff to try to address them,” Ms. Kofman said, noting that it’s hard to delve into the details until legislative text is released in the coming days.

Analysts said this arrangement would likely rely on national plans on the District’s small-business exchange — CareFirst Blue Cross Blue Shield is a key player in the District — that have doctors networks across the country and already cover district-office congressional staff.

“Blue plans are basically everywhere, and they all contract with each other,” said Timothy Jost, a law professor at Washington and Lee University who closely tracks the debate.

Partisan battle lines over Obamacare will make it difficult to enact legislative fixes, however, so most of the focus has been on what the Trump administration can do on its own to place the exchanges on firmer economic footing while maintaining enrollment.

It recently finalized a proposal to slash Obamacare’s open-enrollment season in half so people begin paying premiums once the plan year begins and tighten up “special enrollment periods” so people don’t game them by waiting until they get sick to sign up.

More recently, the Centers for Medicare and Medicaid Services quietly announced plans to let people circumvent HealthCare.gov by using private-sector websites authorized to conduct direct enrollment by sending application data to federal web resources behind the scenes and getting a response, which it then relays back to the customer.

“We’ve always believed the appropriate role for government was to determine if someone was eligible for a tax credit or not,” said John Desser, a former George W. Bush administration health official and senior vice president for government affairs at eHealth, a website that connects users with insurance. “Once we know they’re eligible, let the private sector do all the sales, marketing and enrollment.”

HealthCare.gov has been relatively stable since its notorious crash upon launch in fall 2013, though Mr. Desser argues that the system is still clunky.

“It still goes down from time to time; they have waiting rooms,” he said. “We’ve never had a waiting room in 20 years of business.”

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