State insurance regulators Wednesday called on Congress to help stabilize health insurance markets around the country as the Senate began an unusual bipartisan push to protect markets created by the Affordable Care Act from turmoil partly fueled by the Trump administration.
State officials — both Republican and Democratic — urged lawmakers to maintain the federal funding that subsidizes poor customers' deductibles and co-pays, even as the president continues to threaten to withhold that aid.
And they called on Congress to move quickly in the face of mounting warnings from health insurers that without congressional action by the end of September, consumers will face major premium hikes next year.
"Uncertainty destabilizes the market," Lori Wing-Heier, Alaska's nonpartisan insurance regulator, told senators at the Senate health committee.
Committee Chairman Lamar Alexander (R-Tenn.) and ranking member Sen. Patty Murray (D-Wash.) convened the hearing as one of four over the next two weeks aimed at developing limited fixes for markets that serve nearly 20 million Americans who don't get health coverage through an employer or a government health plan.
Alexander, Murray and others expressed hope that the testimony would lay the foundation for future breakthroughs in the bitter 7 1/2 year battle over the 2010 healthcare law, often called Obamacare.
"This is the way Americans expect the United States Senate to work," said Alexander, calling on senators to embrace compromise.
The growing interest in bipartisan fixes to the healthcare law follows the collapse over the summer of Republicans' repeal campaign amid widespread criticism that GOP legislation would have stripped insurance protections from tens of millions of Americans.
The effort has acquired new urgency as the Trump administration has taken a series of steps that risk sabotaging insurance markets, according to many health insurers, patient advocates and state regulators.
Trump, who has repeatedly threatened to let the law "implode," continues to say he may withhold monthly payments to insurers that help them offer lower co-pays and deductibles to millions of low-income consumers.
The uncertainty over these cost-sharing reduction payments — or CSRs — has prompted numerous insurers around the country to warn that they must raise premiums by double digits next year to account for the possibility that they won't get the federal assistance.
The Trump administration last week also announced a dramatic cut in federal efforts to help people enroll in health coverage, pulling back support for organizations that assist consumers and slashing planned advertising for the 2018 enrollment period by 90%.
Trump's hostility to the health law was echoed Wednesday by Oklahoma insurance commissioner John Doak, a Republican who called for a wholesale overhaul of the law.
But other insurance commissioners testifying before the health committee struck a more pragmatic tone, telling senators that assuring CSR payments in 2018 and beyond is critical to protecting consumers.
Tennessee's regulator, Republican Julie McPeak, called it "the single most important issue" to stabilizing markets.
McPeak and other insurance regulators also called on Congress to create a better system to protect insurers from big losses if they are hit with very costly patients.
Such so-called reinsurance systems are used in other marketplaces such as the Medicare Part D prescription drug program and are seen as critical to controlling premiums.
And several commissioners Wednesday urged lawmakers to reverse the cuts in the enrollment assistance proposed by the administration.
"Encouraging enrollment helps everyone," said former Pennsylvania insurance commissioner Teresa Miller, who recently became the state's acting human services secretary.
Miller and others noted it is particularly important to getting younger, healthier people into the market, which helps keep overall premiums down.
Alexander, the committee chairman, said he wanted senators to settle on a limited package of fixes by the end of next week, expressing support for funding CSR payments in 2018 while also giving states additional flexibility to adjust insurance requirements established by the 2010 law.
Republicans, he said, would have to accept more funding for the 2010 healthcare law while Democrats would have to agree to loosening some federal rules.
"This is a compromise we ought to be able to accept," Alexander said.
Murray, the senior Democrat, also spoke hopefully about the possibility of compromise, though she warned that CSR funding should be assured for more than just one more year.