[Congressional Record Volume 163, Number 175 (Monday, October 30, 2017)]
[Senate]
[Pages S6866-S6868]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. ALEXANDER. Mr. President, when the 18 million Americans in the 
individual insurance market--those are Americans, shopkeepers, 
songwriters, farmers, men and women who don't get their health 
insurance from the government or on the job--begin enrolling on 
Wednesday, they will discover something very strange.
  The Wall Street Journal, in a weekend story, explained exactly how 
strange this phenomenon will be. Some of these 18 million Americans 
will be able to get their insurance for free. They will pay absolutely 
nothing for their premium, but others will see their premiums skyrocket 
far beyond the increases they have seen in recent years.
  Here is what the Wall Street Journal says:

       In nearly all of the 2,722 counties included in the data, 
     some consumers will be able to obtain free health insurance 
     because they qualify for larger federal premium subsidies 
     that cover the full cost of the plan, according to the new 
     analysis.

  The Wall Street Journal continues:

       In the coming weeks, insurers are gearing up to promote the 
     no-premium option. . . . On the flip side, those who don't 
     get premium subsidies under the 2010 law may be responsible 
     for the full brunt of steep rate increases, though they may 
     be able to mitigate the impact by staying away from silver 
     plans.

  Insurers are gearing up to shepherd Americans into plans that will 
cost zero because taxpayers will be paying much higher subsidies. 
Meanwhile, the 9 million Americans in the individual health insurance 
market who do not have subsidies may be responsible for what the Wall 
Street Journal calls the ``full brunt of steep rate increases.''
  What is causing this strange phenomenon? It is happening because 
Congress--us--has not funded cost-sharing reduction subsidies, or CSRs, 
for the 2018 plan year. Cost-sharing reduction subsidies are payments 
in the Affordable Care Act which the government makes to insurance 
companies to reimburse them for deductibles and copays for many low-
income Americans. According to the U.S. District Court for the District 
of Columbia, the President of the United States can no longer make 
these payments himself without the approval of Congress so President 
Trump ended those payments this month.
  Insurance companies have raised premiums to make up the difference, 
loading most of the increase on the silver plan premiums. They did that 
because, under the Affordable Care Act, subsidies are based on silver 
plan premiums. So as premiums go up, subsidies go up. If silver plan 
premiums skyrocket, then the subsidies skyrocket, and then you can use 
your giant subsidy to go buy a bronze plan and pay nothing in premiums.
  In California alone, according to the Wall Street Journal article, 
about half of the 1.1 million who buy health insurance with subsidies 
can get their insurance for free next year. To be clear, because 
Congress didn't provide temporary funding for the cost-sharing 
reductions for 2018, more than half of Californians on the ACA exchange 
can get free government-paid healthcare.
  For the last few weeks, I have been saying that the chaos we are 
going to see, if we don't continue the cost-sharing payments, will be a 
four-lane highway to single-payer insurance. Now we see why. Premium-
free private insurance for millions funded by the taxpayer--I am not 
sure what is conservative about that.
  We don't need to worry about the insurance companies. They obviously 
know how to take care of themselves. As the article details, if the 
cost-sharing payments aren't made over 2 years, insurance companies 
shouldn't lose a penny. They have to pay, under law,

[[Page S6867]]

the copays and deductibles, but they have already secured permission to 
raise premiums for 2018 to cover that. Because courts have said the 
payments are illegal, they secured approval of rates that are 20 
percent higher in 2018 just for this purpose. So the insurance 
companies are not hurt by stopping the cost-sharing reduction payments.
  If subsidized Americans aren't hurt by stopping the payments and 
insurance companies aren't hurt by stopping the payments, then who is 
hurt by stopping the payments? Hard-working, low-income Americans 
making less than $11,000 a year who don't qualify for Medicaid and 
Americans who make more than $47,000 a year and who therefore have no 
government subsidy to help buy insurance. They must face these premium 
increases on their own.
  A hard-working Tennessean in the individual market--let's take a look 
at her. She has already seen her premiums increase 176 percent over the 
last 4 years. For 2018, it is going to be up another 36 percent in 
Tennessee, on average. She will pay the whole bill, no government help.
  Then take the American taxpayers. The Congressional Budget Office 
tells us that failure to continue the cost-sharing reduction payments 
increases premiums and therefore the subsidies to pay for those 
premiums by $194 billion over 10 years--$194 billion over 10 years 
added to the Federal debt because we don't continue the cost-sharing 
subsidies.

  How do we avoid this? Believe it or not, we can avoid this situation 
by enacting a bill that will both prevent this strange phenomenon and 
reduce the Federal deficit by $3.8 billion. Senator Murray from 
Washington, the ranking Democrat on the Senate HELP Committee, and I 
introduced this bill. We were among 12 Republicans and 12 Democrats 
last week who proposed the bill and recommended it to the Senate, to 
the President, and to the House of Representatives after we conducted 
four hearings. In addition, we invited Senators not on the Senate HELP 
committee to join us in the development of this bill, and 37 showed up. 
We had about 60 of us who had some participation in the development of 
this proposal that Senator Murray and I recommended. We presented to 
the Senate our recommendation for continuing cost sharing and giving 
States more flexibility in approving premiums so people would have more 
choices and lower prices.
  You may have noticed that a growing number of Republicans and 
conservatives are recommending that Congress act to continue for 2 
years the so-called cost-sharing reduction payments as copays and 
deductibles for low-income Americans. The heads of the two tax-writing 
committees, Senator Hatch and Representative Kevin Brady, introduced 
legislation that would continue cost sharing in 2018 and 2019. In fact, 
earlier this year, almost all House Republicans voted to continue cost 
sharing for 2 years as part of their repeal-and-replace ObamaCare bill. 
Senators Bill Cassidy and Lindsey Graham have said the provision to 
continue cost sharing temporarily would have been a part of their 
Senate repeal-and-replace bill, but Senate budget reconciliation rules 
didn't allow it.
  President Trump has recognized this. He has asked for a short-term 
bill to prevent this kind of chaos. He encouraged me to talk to Senator 
Murray about this and to use cost-sharing reduction continuation as a 
way to negotiate some more flexibility for States so they could approve 
more choices at lower prices, which is exactly what Senator Murray and 
I did. That is what we recommended--the 24 of us, 12 Republicans and 12 
Democrats--to the full Senate last week.
  Some people still worry that continuing the cost-sharing payments is 
the same thing as propping up ObamaCare--those are the words we hear--
or bailing out insurance companies. We hear those words too. In fact, 
just the reverse is true.
  As the article explains in the Wall Street Journal, cutting off the 
cost-sharing payments, in the current circumstances, would increase 
insurance premiums on hard-working Americans who have no government 
subsidies, it would increase the Federal debt by nearly $200 billion 
over 10 years, and it would spend billions more in taxpayer dollars 
funding ObamaCare subsidies. Let me say that again. As the Wall Street 
Journal article explains, cutting off the cost-sharing payments in the 
current circumstances will increase insurance premiums on hard-working 
Americans who receive no government subsidies--up 36 percent in 
Tennessee--increase the Federal debt by $200 billion over 10 years, and 
spend billions more in taxpayer dollars funding ObamaCare subsidies.
  There are two groups of people who would be basically held harmless 
if Congress does not approve the cost-sharing payments; one, Americans 
with ObamaCare subsidies; and, two, insurance companies. On the other 
hand, according to the CBO report last week, continuing the cost-
sharing subsidies as part of the Alexander-Murray agreement would 
actually save taxpayers $4 billion by reducing premiums and therefore 
ObamaCare premium subsidies.
  During 2018, it would provide rebates to consumers State by State to 
those hard-working Americans with no government subsidy, and it would 
begin to lower premiums in 2019. It would also give all Americans the 
opportunity to buy a new category of policy--catastrophic--so that a 
medical catastrophe doesn't turn into a financial catastrophe, and it 
would give States more flexibility to write policies with more choices 
at lower prices.
  Many States want to do that. They need these additional flexibilities 
to stabilize their markets because problems with the individual market 
did not start with the uncertainty over the cost-sharing payments. We 
need to return power over the insurance markets to States if we want to 
begin creating long-term solutions.
  The President and many others have said they don't want to bail out 
insurance companies. I don't want to bail out insurance companies. 
Senator Murray doesn't want to bail out insurance companies. I don't 
think I have run into anybody in the U.S. Senate who wants to bail out 
insurance companies. Our agreement doesn't bail out insurance 
companies. In fact, it does just the reverse.
  If President Trump is looking for his majority, he might find it in 
Americans who don't like higher taxes and who don't like more 
government funding for ObamaCare subsidies. Somewhere the idea got 
started that continuing cost-sharing payments bails out insurance 
companies, but insurance companies are big boys and girls. They know 
how to take care of themselves, and they have proved it once again.
  Failure to continue the cost-sharing subsidies is going to hurt 
taxpayers, and it is going to hurt unsubsidized Americans who have no 
subsidy to help buy their insurance. There is nothing conservative 
about that.
  Before I yield the floor, I ask unanimous consent to have printed in 
the Record an article from the Wall Street Journal Weekend Edition 
entitled ``More ACA Plans to Come With No Premiums in 2018.''
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

             [From the Wall Street Journal, Oct. 27, 2017]

            More ACA Plans To Come With No Premiums in 2018

             (By Anna Wilde Mathews and Christopher Weaver)

       Trump indirectly bolstered the federal subsidies that help 
     consumers with their insurance premiums.
       More people will be eligible in 2018 for no-premium health 
     plans under the Affordable Care Act.
       Insurers selling Affordable Care Act plans have a 
     compelling new pitch: free health insurance.
       When sales of plans on the law's exchanges begin Nov. 1, a 
     growing number of consumers around the country will be able 
     to get coverage for 2018 without paying any monthly premium, 
     according to health insurers and an analysis of newly 
     available federal data.
       In nearly all of the 2,722 counties included in the data, 
     some consumers will be able to obtain free health insurance 
     because they qualify for larger federal premium subsidies 
     that cover the full cost of a plan, according to the new 
     analysis.
       The growing availability of no-premium plans is a side 
     effect of a decision by President Donald Trump's 
     administration to end federal payments that are used to 
     reduce out-of-pocket costs, such as deductibles, for low-
     income enrollees. The administration didn't halt--and 
     indirectly bolstered--the federal subsidies that help 
     consumers with their insurance premiums.
       The new analysis doesn't project exactly how many consumers 
     could be eligible for the no-premium plans, a figure that 
     depends

[[Page S6868]]

     on variables including people's income, household size, age, 
     location and access to other types of health coverage.
       In the coming weeks, insurers are gearing up to promote the 
     no-premium option. Amid uncertainty about the future of the 
     2010 health law, known as Obamacare, many insurers have 
     pulled back from the law's marketplaces. Many of the 
     remaining ones are worried about losing enrollment next 
     year--largely among consumers who aren't eligible for 
     subsidies and won't be able to get premium-free plans.
       Insurers hope the no-premium insurance draws in more 
     enrollees, particularly those they need most: people with few 
     health needs. Healthy consumers help bolster the stability of 
     the market by balancing out the health costs of sicker 
     enrollees.
       ``We absolutely will be promoting this opportunity to get 
     coverage at a zero price,'' said Wendy Curran, a spokeswoman 
     for Blue Cross Blue Shield of Wyoming, which is mentioning 
     the no-premium plans in print, radio and social-media 
     advertising. ``We hope those younger people will say, `Well 
     yeah, if it's not going to cost me anything, sure.' ''
       Ms. Curran said it was ``astounding even to us'' how many 
     people will be able to get no-premium insurance in Wyoming.
       The no-premium plans will also receive a hefty promotional 
     push from insurance agents. EHealth Inc. and HealthMarkets 
     Inc., both big national agencies, said they're preparing to 
     highlight the option in advertising and other outreach. 
     ``It's just the idea of something free being really 
     appealing,'' said Nate Purpura, a vice president at eHealth. 
     The company's surveys have consistently shown that price is 
     the most important factor in consumers' choice of plan, he 
     said.
       Availability will vary by age and income, but some 
     enrollees who don't have a very low income may be able to 
     land zero-premium coverage, according to the analysis of 
     federal data conducted by consulting firm Oliver Wyman, a 
     unit of Marsh & McLennan. The firm found that zero-premium 
     ACA exchange plans would be available next year to at least 
     some consumers in a total of 2,692 counties, out of 2,722 in 
     the study.
       A 60-year-old making about $36,000 a year could find free 
     2018 plans in 1,590 counties, while one with income of about 
     $48,000 could do so in 654 counties, according to the 
     analysis, which used data released Wednesday for plans 
     available on HealthCare.gov, the federal marketplace used by 
     39 states.
       For 2017, no-premium plans were available in many places 
     for the very lowest-income enrollees, but for those at 
     slightly higher levels, they were much more scarce. For 
     instance, in 2017, a 60-year-old making about $36,000 could 
     find free plans in about 300 of the counties.
       That is what is different in 2018, said Kurt Giesa, a 
     partner at Oliver Wyman. The zero-premium plans are ``much 
     more prevalent now than they were,'' he said.
       In California, which isn't included in the federal data, 
     there is a ``huge increase from last year'' in the number of 
     people who are eligible for zero-premium plans, said Peter V. 
     Lee, executive director of Covered California, the state's 
     ACA exchange. Covered California currently has about 1.1 
     million enrollees who receive federal-premium subsidies, and 
     more than half of them will be able to buy a no-premium plan 
     for 2018, he said.
       The growing availability of no-premium plans is tied to the 
     complicated dynamics of the 2010 heath law, as well as a 
     recent move by the GOP president.
       Under the law's rules, subsidies that help pay for premiums 
     are available to people making up to about $48,000 a year. 
     Those subsidy amounts are linked to the cost of the second-
     cheapest silver plan in an enrollee's location. So, when 
     silver premiums go up, subsidies go up.
       Earlier this month, Mr. Trump's administration cut off 
     federal payments to insurers for covering certain out-of-
     pocket costs for low-income enrollees in silver plans. In 
     response, insurers raised premiums on their 2018 policies 
     sharply to cover the extra expense, now coming out of their 
     pockets--and in many cases, they loaded the extra boost only 
     onto the silver plans. Because the separate premium 
     subsidies, which Mr. Trump didn't cut, are linked to silver-
     plan prices, those subsidies are rising, too. In many states, 
     the costs for cheaper bronze plans are going up much less 
     rapidly than silver plans, so many more people will wind up 
     being eligible for no-premium plans.
       On the flip side, those who don't get premium subsidies 
     under the 2010 law may be responsible for the full brunt of 
     steep rate increases, though they may be able to mitigate the 
     impact by staying away from silver plans.
       For those who can get free plans, the lure may be 
     irresistible.
       Medica, an insurer that is offering exchange plans in 
     states including Iowa, Nebraska and Wisconsin, is running ads 
     in some places that say ``$0 premium plans for individuals 
     who qualify.'' It is also sending letters to some current 
     exchange enrollees with bronze plans, who are likely to be 
     enrolled with Medica in 2018, informing them that they can 
     stop paying premiums next year. ``That's a nice letter to 
     get,'' said Geoff Bartsh, a vice president at Medica.
       Jerry Dworak, chief executive of Montana Health Co-op, 
     said, ``of course we're hoping that'' young and healthy 
     enrollees flock to the no-premium plans.
       ``If they see that it's free, why not take it?,'' he said.
       Mr. Dworak said that a person making as much as $33,000 a 
     year could get one of his company's Idaho plans and pay no 
     premium.
       The plans may attract more older consumers than younger 
     because premiums and subsidies rise with age, making free 
     plans more available to older people.
       And for some, the zero-premium plans won't actually be the 
     best deal, insurers and insurance agents say. The silver 
     plans could be cheaper overall for people who use much health 
     care, despite their higher premium costs, if these people are 
     eligible for the health law's cost sharing help.
       According to HealthCare.gov, for instance, a 40-year-old 
     man in Cheyenne, Wyo., who makes about $24,000 a year could 
     get a zero-premium bronze plan, but he could pay as much as 
     $6,650 over the course of 2018 in deductibles and other out-
     of-pocket charges. Or he could get a silver plan that would 
     cost him around $125 a month, but cap his out-of-pocket costs 
     at $2,450.
       ``There's this trade-off,'' said Michael Z. Stahl, a senior 
     vice president at HealthMarkets, who said the company's 
     agents will walk through the pros and cons with clients.

  Mr. ALEXANDER. I yield the floor.
  Mr. REED. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. McCONNELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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