On Wednesday, September 6 the Senate HELP Committee began an initial series of four hearings over two weeks.  Chairman Senator Lamar Alexander (R-TN) struck a strong bipartisan note at the beginning of the hearing indicating that he wanted to find a basic quick bipartisan fix for some key issues and have an agreement together through the Committee near the end of this week.

The Wednesday hearings included the testimony of five state insurance commissioners/leading regulators from Tennessee, Washington state, Pennsylvania Alaska and Oklahoma.  The Thursday hearing include testimony from governors from Tennessee, Massachusetts, Montana, Utah and Colorado.  This week’s hearings will focus on state flexibility and block grants and the Thursday hearing will include testimony from a range of health care advocates.

Three key issues emerged as far as a quick fix that could stabilize the insurance markets: guaranteeing the funding for the Cost Sharing Reduction (CSR), re-insurance funding, a more streamlined waiver authority then the current ACA waivers.

Chairman Alexander asked the five Governors to send any additional proposals that could move quickly back to the Committee by the middle of this week.

The hearing attracted so much interest that virtually all members of the Committee attended.  The only exceptions on the Republican side were Senator Orrin Hatch (R-UT), Senator Johnny Isakson (R-GA) and Senator Tim Scott (R-SC) who attended briefly but left before asking questions. On the Democratic side, all members and one non-member (Senator Tom Carper) showed up and all remained to ask a series of questions except for Senator Bernie Sanders (I-VT). The hearing was proceeded each hearing day with a pre-coffee session where Senators could gather to have informal discussions. Chairman Alexander indicated that they had 30 members on the first day.

The CSRs are the subsidies that are funneled through insurance companies to lower some co-pays and deductible for some purchasers.  These are the funds that were under lawsuit first by the Speaker of the House John Boehner (R-OH) and have been under a questionable legal status so much so that the President has threatened to withhold the approximate $7 billion in funding as a way to collapse the system.

The re-insurance funding existed earlier in the ACA and helps some markets where the pool of insured may include some very high cost patients with the reinsurance funding used to address some of those high costs and thus reduce overall premiums.

The waiver authority already exists under the ACA. States can request some limited waivers of some of the ACA requirements.  Most testimony focused on the minimum six-month time frame it takes to get a CMS response.  Concerns were also raised about the budget neutrality requirement of these waiver applications.

A more partisan concern is the inability to waive the essential benefits package.  This could be the most contentious issue with some Republicans including Alexander indicating that items such as the essential benefits package should be open for discussion.  These minimum coverage provisions require policies to cover mental health and substance use treatment services.  Democrats will be unlikely to give up on these requirements.

The first hearings have run nearly three hours each with a strong consensus by most speakers and Senators pleased to have a bipartisan approach. Senator Alexander has framed these first hearings as focusing on the 6 percent of individuals that buy their own insurance.  He highlighted these 18 million people as being the current concern and focus with half of these 18 million not receiving any federal subsidy.

Alexander then said after an initial package he wants to focus more attention controlling health care costs and improving health care prevention.  If the HELP Committee can get a bipartisan deal, that may be the easiest threshold.  The Senate Finance Committee which has control of any tax pieces and Medicaid/Medicare parts of the ACA could also serve as a roadblock even though the HELP bill will be limited to provisions under its jurisdiction.