In the face of Trump threats to end subsidies, Tennessee's insurance chief says they are critical to health care

WASHINGTON — Tennessee Insurance Commissioner Julie Mix McPeak urged Congress on Wednesday to continue federal cost-sharing payments to insurers, arguing the subsidies are the key to strengthening insurance markets and potentially bringing down costs next year.

Appearing before a Senate panel, McPeak insisted the payments should not be seen as an “insurer bailout.”

To the contrary, she said, cost-sharing funding “ensures that some of our most vulnerable consumers receive assistance for copays and deductibles that are required to be paid under federal law.”

McPeak’s testimony before the Senate Health, Education, Labor and Pensions Committee came during the first of four hearings focused on strengthening the individual health insurance market after the collapse of the GOP’s effort to repeal the Affordable Care Act, or Obamacare.

Sen. Lamar Alexander, the Tennessee Republican who chairs the panel, said he hopes lawmakers will reach a consensus by the end of next week and approve bipartisan legislation by the end of the month to stabilize the individual health insurance market and guarantee that affordable coverage is available for those who want it.

“To get a result, Democrats will have to agree to something — more flexibility for states — that some may be reluctant to support,” Alexander said. “And Republicans will have to agree to something — additional funding through the Affordable Care Act — that some may be reluctant to support. That is called a compromise.”

“Health insurance has been a very partisan topic for a very long time,” he said, “but the bottom line is that 18 million Americans need our help. I hope we can stay focused on getting a result.”

Unless Congress steps in, millions of Americans may find themselves stuck with policies next year they can’t afford — if they are able to buy insurance at all.

At Wednesday’s three-hour hearing, McPeak, president-elect of the National Association of Insurance Commissioners, testified alongside the top state insurance regulators from Washington, Pennsylvania, Alaska and Oklahoma.

Health insurance markets remain near collapse in several states and are challenged in many others, McPeak said.

McPeak had warned last year that Tennessee’s insurance market was “very near collapse.” While that hasn’t happened, “our market is not any more stable and probably less so" than it was late last year, she said.

Sen. Chris Murphy, D-Conn., cited McPeak’s remarks about the volatility of Tennessee’s insurance market as an example the “rhetoric” that he said often surrounds the Affordable Care Act.

“You said you were on the verge of collapse. You didn’t collapse,” Murphy said. “What does that say about how these marketplaces are and have been holding together?”

McPeak responded that insurance carriers have been fleeing the market in Tennessee year after year under Obamacare. In 78 of the state’s 95 counties, only one insurance carrier offers coverage on the marketplace, she said.

Tennessee’s current trajectory “quite simply is not sustainable into the extended future,” McPeak warned.

Whatever Congress does to stabilize the markets, it must act quickly, McPeak said, because states are facing a Sept. 20 deadline to make final decisions on rate filings for 2018. New insurance rates must be posted on the federal government’s website, healthcare.gov., by Sept. 27.

The cost-sharing payments have become a focal point as Congress looks for ways to stabilize the market.

The federal government provides the funding to insurers to help them offer lower co-payments and deductibles to nearly 6 million low- and moderate-income families. Alexander and others have said they want the payments to continue.

President Donald Trump, however, has threatened to end the payments, worth about $7 billion this year. The nonpartisan Congressional Budget Office projects that premiums would rise 20 percent to 25 percent and the federal deficit would increase if Trump cancels the payments.

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The four insurance commissioners who testified alongside McPeak also said the cost-sharing payments should continue.

For those who struggle to meet basic needs such as food and housing, cost-sharing payments will make a difference in whether they decide to buy insurance and whether they can afford to see a doctor, said Washington state Insurance Commissioner Mike Kreidler.

Asked by Sen. Elizabeth Warren, D-Mass., about the impact that eliminating cost-sharing payments would have on Americans, McPeak replied: “If those payments are not funded, the American consumer is worse off.”

Besides the cost-sharing payments, McPeak told the committee that broader reforms also are needed to help stabilize the individual market.

She urged lawmakers to consider establishing a short-term reinsurance mechanism that would protect insurers from extremely high claims from some individuals. She also said states need more flexibility in approving policies to help reach younger consumers who want to buy insurance but haven’t because of high premiums.

In addition, McPeak and Pennsylvania Insurance Commissioner Teresa Miller urged Congress to begin a broader conversation about what is driving up the cost of health insurance and specifically the costs of health-care services.

“We can continue to look for solutions to these problems at the state level,” Miller said, “but these are national problems that I believe merit national solutions.”

On Thursday, the Senate panel will hold its second hearing on stabilizing the individual market. Tennessee Gov. Bill Haslam and governors from Massachusetts, Montana, Utah and Colorado are scheduled to testify.