Democrats are beginning to talk about changing ObamaCare to fix what they acknowledge are growing problems in the law’s insurance marketplaces.
Insurers have been dropping out of ObamaCare or hiking their premiums this year due to financial losses, fueling Republican criticism of the law ahead of the November elections.
While Democrats are pushing back at the GOP attacks, they are also expressing hope that Republicans will work with them to make fixes to the law when the new Congress convenes in 2017.
“There are things we can do and need to do to address restoring competition in these exchanges, and my hope is when we’re through the elections and past the elections, we’ll do those,” Sen. Tom CarperThomas (Tom) Richard CarperPlastics industry lashes out at 'regressive' Democratic tax plan Overnight Energy & Environment — Presented by the League of Conservation Voters — EPA finalizing rule cutting HFCs EPA finalizes rule cutting use of potent greenhouse gas used in refrigeration MORE (D-Del.) said.
Carper pointed, for example, to improving the health law’s “three Rs,” which refer to programs that were created to shield insurers from high costs and losses. Republicans have attacked these programs as a “bailout” of insurers and have restricted taxpayer money from being used on them, putting a strain on insurer finances.
Another potential change to the law would be to tighten the rules for special signup periods.
Insurers complain people are signing up only after they get sick. While Health and Human Services (HHS) Secretary Sylvia Mathews Burwell is trying to address that issue, Sen. Chris MurphyChristopher (Chris) Scott MurphyThis week: Democrats hit make-or-break moment for Biden Democrats urge Biden to go all in with agenda in limbo Congress facing shutdown, debt crisis with no plan B MORE (D-Conn.) said her efforts might not be enough.
“There’s going to be ups and downs in these marketplaces,” Murphy said. “I think the secretary’s got some ability to try to smooth out these edges, and there are other things that ultimately we might want to talk about legislatively. She’s only got so much ability, but there’s clearly people getting into these exchanges mid-enrollment period that shouldn’t be, and that’s one of the things that’s upsetting some of the actuarial data.”
Asked if he was concerned that the situation could get worse on the exchanges, Murphy said: “You know, I think the Affordable Care Act [ACA] from the very beginning has been a roller coaster. There are a lot more ups and downs.”
Burwell spoke directly to Senate Democrats during their caucus lunch last Thursday and discussed ways that the healthcare law could be improved.
Sen. Chris CoonsChris Andrew CoonsManchin raises red flag on carbon tax Dems punch back over GOP holdup of Biden SBA nominee Biden threatens more sanctions on Ethiopia, Eritrea over Tigray conflict MORE (D-Del.) said Burwell “answered many tough questions on how to improve the competitiveness of the marketplace, stabilize plans and improve access and affordability.”
HHS distributed a packet to the senators with slides highlighting statistics. One stated that 20 million people have gained coverage under the law, while another highlighted how employer plans have seen smaller premium increases since passage.
The packet also pointed out that the law’s financial assistance defrays the cost of premium rate increases for 85 percent of enrollees and gave examples of “Coverage of Administration Push-Back on Rates,” highlighting positive articles in the media.
HHS has already been taking some steps in trying to shore up the stability of the marketplaces. It has made changes to the formula for risk adjustment, which shifts money to insurers with higher-cost enrollees, and tightened the rules somewhat for the extra signup periods.
But many Democratic senators want to act much more ambitiously, through the legislative process. There are now 33 senators who have signed on to a resolution from Sen. Jeff MerkleyJeff MerkleyOvernight Energy & Environment — Presented by the League of Conservation Voters — Senate Finance chair backs budget action on fossil fuel subsidies Top Democrat says he'll push to address fossil fuel tax breaks in spending bill Democrats revive filibuster fight over voting rights bill MORE (D-Ore.) calling for adding a government-run insurer, or “public option,” to ObamaCare.
President Obama and Democratic presidential nominee Hillary ClintonHillary Diane Rodham ClintonDemocrats worry negative images are defining White House Heller won't say if Biden won election Whitmer trailing GOP challenger by 6 points in Michigan governor race: poll MORE have also called for versions of the public option in order to increase competition.
While the administration downplayed Aetna’s announcement in August that it would drop out of many ObamaCare marketplaces, Merkley pointed to the company’s decision as highlighting the need for a public option. He said Aetna’s decision was made in retaliation to the Department of Justice blocking its merger.
“I don’t think we need any more proof that a public option is critical to bringing more competition and accountability to the insurance market,” Merkley wrote in an email to members of the Progressive Change Campaign Committee last week.
While a public option has no chance of passing Congress, as long as Republicans control the House or Senate, Democrats hope Republicans will join them to make smaller fixes, especially if Clinton wins the presidency in November.
The question is how Republicans would play their hand in that situation.
Rep. Diana DeGette (D-Colo.) said at a hearing last week that some Republicans had spoken with her privately about fixing the law.
“At this point, Republicans aren’t willing to admit to the public that the law has helped millions of people and simply needs fixing rather than being repealed,” DeGette said. “So far, they’re doing so only in private, in conversation with me, among others. It’s my hope that after the elections, we can all be more straightforward about what needs doing to get the ACA on the right course.”
There have been some signs that Republicans are willing to take actions short of repeal.
In June, Republicans on the House Energy and Commerce Committee surprised healthcare observers by holding a hearing on a range of bills making ObamaCare changes that — while opposed by Democrats — were a far cry from repeal. The changes were strongly favored by insurers as helping to shore up their business on the law’s marketplaces.
Still, Republicans remain strongly opposed to the law. Senate Republicans have been making near-daily trips to the floor to bash ObamaCare, and the issue is cropping up on the campaign trail.
Calls for fixing the law have fallen flat in the GOP before. Shortly after Obama was reelected in 2012, then-Speaker John BoehnerJohn Andrew BoehnerCheney takes shot at Trump: 'I like Republican presidents who win re-election' Cheney allies flock to her defense against Trump challenge Lobbying world MORE (R-Ohio) famously referred to ObamaCare as “the law of the land,” before quickly walking back his statement and saying that he was still committed to “full repeal.”
“I think it’s important to be vigilant, because like any complex area of policy, it’s going to require some changes,” said Sen. Bob CaseyRobert (Bob) Patrick CaseyBiden sidesteps GOP on judicial vacancies, for now Democrats urge Biden to go all in with agenda in limbo House passes bill to ensure abortion access in response to Texas law MORE Jr. (D-Pa.). “What we haven’t had, though, is a bipartisan way to do that yet. Maybe 2017.”
Alexander Bolton contributed.