Legislation to Lower Health Insurance Premiums in Individual Market by up to 40% Proposed for Omnibus Spending Bill

“A self-employed plumber making $60,000 may be paying $20,000 for health insurance. Our proposal could cut up to $8,000 from that insurance bill.”

—Sens. Lamar Alexander and Susan Collins, Congressmen Greg Walden and Ryan Costello

WASHINGTON, March 19, 2018 — Senate health committee Chairman Lamar Alexander (R-Tenn.), Senator Susan Collins (R-Maine), House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) and Representative Ryan Costello (R-Pa.) today proposed legislation that would lower individual health insurance premiums in the individual market up to 40% and said that it should be included in the Omnibus spending bill Congress will consider this week.

“Our recommendations are based upon Senate and House proposals developed in several bipartisan hearings and roundtable discussions,” the four lawmakers said. “According to independent experts, our proposal would reduce premiums in the individual market by up to 40 percent for farmers, songwriters, and small business men and women, and others who don’t receive insurance from the government or from their employer and who pay for insurance on their own. A self-employed plumber making $60,000 may be paying $20,000 for health insurance. Over time, our proposal could cut up to $8000 from that insurance bill.”

Preliminary projections from the Congressional Budget Office indicate that the proposal could be adopted without adding to the federal debt.

Health care experts at management consulting firm Oliver Wyman released an analysis this week comparing this proposal to what people in the individual market will pay if Congress doesn’t act. The analysis showed that this package would reduce premiums by up to 40 percent in the individual market for states that obtain a Section 1332 Affordable Care Act waiver and would provide insurance coverage to an additional 3.2 million individuals. The analysis also factored in increased flexibility for states that seek to use state innovation waivers and applies in the individual health insurance market on and off the exchange.

Background on the proposal:

• Meaningful permanent flexibility for states in revised Section 1332 Affordable Care Act State Innovation Waivers.
• 3 years funding of invisible high risk pools/reinsurance at $10 billion per year, with a federal fallback in the first year. States could set up an invisible high-risk pool based on the Alaska/Maine model, a traditional reinsurance pool, a pool based on another state’s model, or something of their own design.
• Authorizes new copper plans that will allow anyone to buy catastrophic coverage.
• 3 years funding of cost-sharing reduction subsidies. Helps those who are below 250% of the poverty level who receive government assistance to help them pay for their deductibles and co-pays.
• Includes protections so that federal funding directly benefits Americans, not insurance companies.
• Requires the HHS secretary to issue regulations allowing insurers to sell plans across state lines.
• Does not change Affordable Care Act essential benefits requirements or guarantee of insurance for an individual with pre-existing conditions.
• Includes the traditional Hyde protections that have applied to appropriations bills since 1976 and that   apply to Medicaid, Medicare, Children’s Health Insurance Program, TRICARE, Indian Health Service, Federal Employees Health Benefits Program, Veterans Affairs, and the Labor-HHS appropriations bill. Clarifies that Hyde-exemptions and effect on non-federal funding remain the same.
• Requires transparency for consumers purchasing short-term limited duration insurance. States may add additional requirements on top of the federal requirements.

Click here for the text of the proposed legislation.

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