On September 19, 2017, Senator Lamar Alexander (R-TN), Chair of the Senate Health, Education, Labor, and Pension (HELP) Committee, announced that after two weeks of bipartisan hearings on individual market stabilization, Republicans and Democrats “have not found the necessary consensus . . . to put a bill in the Senate leaders’ hands that could be enacted.” Senator Patty Murray (D-WA), the ranking member of the HELP committee, released a statement thanking Senator Alexander for undertaking the bipartisan process. She noted that however that:

We identified significant common ground and I made some tough concessions to move in Chairman Alexander’s direction when it comes to giving states more flexibility. I am disappointed that Republican leaders have decided to freeze this bipartisan approach and are trying to jam through a partisan Trumpcare bill, but I am confident that we can reach a deal if we keep working together—and I am committed to getting that done

Apparently, Republican leaders have decided to concentrate their efforts for the time being on passing the Graham-Cassidy legislation. Perhaps bipartisanship will return to the fore if those efforts fail, but in the meantime the individual market continues to face continuing uncertainty and instability in some parts of the country. A bipartisan group of ten governors, some of whom had testified in the hearings, urged a bipartisan approach rather than pursuit of Graham-Cassidy in a letter to Senate Majority Leader Mitch McConnell (R-KT) and Minority Leader Chuck Schumer (D-NY).

CMS Moves Iowa 1332 Waiver Application Along

Also on September 19, 2017, the Centers for Medicare and Medicaid Services preliminarily declared Iowa’s application for a 1332 state innovation waiver complete, opening a thirty-day comment period. The Iowa waiver is the most radical state innovation waiver proposed to date. It would abandon the ACA’s cost-sharing reductions for low-income residents in Iowa, using the federal funds that would have gone for the reducing cost sharing to fund increased premium credits. These credits would be available to individuals who would qualify for ACA premium tax credits, but they would also be available also to individuals with incomes above 400 percent of the federal poverty level, the maximum income level for ACA tax credits.

The waiver would pull Iowa out of the federal exchange, allowing it to determine premium credit eligibility itself. Iowan individual market consumers would be restricted to a single standardized silver plan, which would be offered under a contract between insurers and the state. Individuals who failed to maintain continuous coverage for twelve months without a sixty-day gap in coverage would be denied access to certain special enrollment periods. Finally, Iowa is requesting pass-through funding for a reinsurance program, but unlike other states that have requested or obtained a 1332 reinsurance waiver, Iowa is not putting up any of its own money for the program.

There are serious questions as to whether the Iowa waiver request complies with certain procedural and substantive requirements of the 1332 innovation waiver program. There is also the matter of how Iowa can possibly implement its program by November 1, 2017, unless it has been putting its program in place without waiver authority. The federal comment period ends on October 19, 2017, and it is very hard to see how CMS could meaningfully consider comments and approve the program for implementation on November 1.

Limits And Disclaimer Regarding Use Of Health Plan Quality Star Ratings

Finally, on September 19, 2017, CMS released a frequently asked question at its REGTAP.info website stating that agents, brokers, and insurers directly enrolling individuals through HealthCare.gov will only be allowed to display health plan quality star ratings in Virginia and Wisconsin, the two states in which the quality rating pilot was in operation this year. They must include a standard disclaimer noting that the quality rating program is still being tested.