WASHINGTON -- Ohio U.S. Sen. Rob Portman said Thursday he doesn't yet support efforts to restore money to insurance companies under the Affordable Care Act, saying the legislation still doesn't do enough to reduce insurance premiums and help Ohioans.
Even if the money was restored, he said, premiums for ACA policies would rise by an average of 23 percent next year in Ohio. While lower than the 34 percent average hike scheduled to go in effect in 2018 because of a decision by President Donald Trump last week, it is nevertheless too sharp a jump, Portman, a Republican said.
That 23 percent average hike would have to be paid by a share of Ohioans who get no government help to cover their premiums. They and all other Ohioans need relief, such as better ability to fund health savings accounts and more waivers from the ACA's other requirements, Portman said.
It is possible Portman could change his mind as the legislation offered this week by Sens. Lamar Alexander, Republican of Tennessee, and Patty Murray, Democrat of Washington, is changed or negotiated. Portman said he is working with colleagues to see if there is a solution.
"I think if we're going to legislate on it, it should be something that actually makes a difference in a significant way," Portman said, discussing the bill with reporters in his office.
Portman's reluctance could signal broader trouble for the bill by Alexander and Murray, respectively the top Republican and Democrat on the Senate health committee. Trump has equivocated on his support, criticizing the bill as a giveaway to insurers yet also suggesting a deal could still be made.
With more conservative congressional Republicans opposing any bill that lets the ACA, or Obamacare, continue, moderates like Portman would be needed for passage. Portman said the bill could require 60 votes to pass procedural hurdles. If so, it could take not only all 48 Senate Democrats but also affirmative votes from 12 Republicans.
Passage in the House of Representatives could be tougher, as the Republican majority there has voted repeatedly to simply repeal the ACA -- something the Senate, with a smaller GOP majority, has lacked the votes to do.
The Alexander-Murray bill, Portman said, needs to do more to address "the cost issue," or the price of insurance regardless of subsidies. And it needs to offer flexibility beyond some of the measures already offered, he said. Those measures now in the bill include full funding for cost-sharing payments through 2019, an easier path for states to get around certain ACA requirements, and enrollment options for a bare-bones, catastrophic level of coverage that now is mostly for people under age 30.
Portman said he wants to see about money going to heath savings accounts for people with low incomes instead of it going directly to insurance companies. That would give those buyers more flexibility in their decisions, he said.
"For a lot of low-income Ohioans, that would be good," he said.
As for the bill's prospects right now, "I think its chances are not good," Portman said.
Trump last week said the government will stop paying ACA insurers for cost-sharing reductions, which insurers used in turn to reduce deductibles and other out-of-pocket costs for lower-income policy buyers. Trump and congressional conservatives want wholesale changes to the 2010 health care bill, which they say drove up insurance premiums while forcing too many Americans to buy coverage they don't want or need.
By ending cost-sharing payments to insurers, Trump potentially weakens the ACA's very structure, serving his goal of dismantling the insurance program or letting it implode, as he has suggested. That would happen if insurance companies pulled out of too many markets, fearing a loss of revenue or a financial squeeze as customers balk at higher premiums, especially customers with incomes too high to qualify for premium subsidies.
Alexander and Murray this week offered bipartisan legislation to provide temporary cost-sharing payments until broader ACA reforms could be addressed. Portman until now was seen as a potential supporter of that legislation, and a crucial supporter, too, because of the political calculus needed for passage if more conservative lawmakers balked as expected.
But Portman says he, like others in his party, has concerns about the Alexander-Murray bill.
As for whether this is a reversal, Portman recently said he supported continuing cost-sharing payments in the short-term and had hoped Trump would keep making them. And his office had said he supported the Alexander-Murray discussions. But he said he did not support this specific legislation they put forward.
His press secretary, Emily Benavides, said last week while Portman "supports the ongoing bipartisan discussions on stabilizing the markets in the short term," he also "believes we need broader reforms to help lower costs and provide more affordable health care options for Ohioans."
The White House said Trump had the legal right to stop making cost-sharing payments because Congress never specifically passed legislation authorizing the expenditures, even though such spending was anticipated when Democrats -- then in control -- wrote and passed the ACA. House of Representatives Republicans raised the legal argument in a 2014 lawsuit to try to stop the payments. A federal court agreed with them last year but the case was continuing on appeal -- and the payments were continuing -- when Trump made his decision.
Even with Trump yanking the funding, the ACA is structured in a way that still will provide insurers with money to pay for cost-sharing reductions -- just indirectly. That is, the ACA still requires them to provide the cost savings to individuals and families with incomes below 250 percent of the poverty level. To cover that expense, insurers can raise their premiums if necessary, lest they lose money and go out of business or leave markets.
This is why without the cost sharing payments, premiums will rise so high -- on average by 34 percent in Ohio in 2018, as opposed to the 23 percent they would rise by otherwise. Certain policies will rise by more, others less.
But a different feature of the ACA -- the feature that subsidizes premiums for people with incomes up to 400 percent of the poverty level -- then will cover those higher premiums. The higher the premiums go, the more the government has to pay in subsidies to cover them.
While it might seem like that solves the problem, albeit at a higher cost to the government, roughly 20 percent of ACA policy buyers get no subsidies. These are the people most likely to drop out of ACA coverage or buy lower-cost policies that require higher out-of-pocket payments. This is all still to play out but potentially could disrupt the mix of customers and benefits insurers count on to balance out their costs. That is what could make the markets tumble.
Sen. Sherrod Brown, an Ohio Democrat and ACA supporter, said he sees no logic in those balking on the the cost-sharing bill. Doing nothing will just bring higher premiums, he said, whether people like the ACA or not.
Brown said he agreed with some of ACA critics that other changes should be made. Every major bill, from civil rights legislation to Medicare, required tinkering over time as various glitches were worked out. The ACA is no different, Brown said.
"It is irresponsible for us to sit around and twiddle our thumbs rather than address this very important health care issue," Brown said.