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Republicans Debate Obamacare Insurance Rules Changes

By Erin Mershon, CQ Roll Call

June 10, 2016—House Republicans pushed a series of legislative measures they see as tweaks aimed at improving the Affordable Care Act at a Friday legislative hearing, but Democrats cautioned that the bills would undermine access to coverage for many Americans.

The Energy and Commerce Health Subcommittee hearing represents a slightly different tack for House Republicans, who have largely focused on efforts to repeal, not tweak, the health law. While Congress somewhat quietly has passed at least 18 laws revising the health law, many Republicans who are fearful of angering conservatives often publicly vow to accept nothing less than full repeal.

The path forward for the changes debated Friday is unclear. Subcommittee chairman Joe Pitts, R-Pa., said there was "time on the schedule for a markup," but no decision had been made on which bills, if any, would receive a vote.

The measures, some of which are still discussion drafts, are largely aimed at insurance industry regulations in the health law. Republicans say walking them back will help address some of the major ongoing complaints with the health law: that it is unaffordable and its markets remain unstable.

"Americans are paying higher premiums and deductibles for health insurance and care as a result of the law," Pitts said. "We can do better. We must make health care costs more transparent and give people the freedom to choose the insurance that they want, with the benefits they value most at a price that is fair."

Insurance companies applauded the proposals. The industry's main lobbying arm America's Health Insurance Plans called them "promising strategies" and said they could help lower premiums and stabilize the marketplace.

But Democrats caution that most of the bills discussed Friday are not pragmatic, bipartisan efforts to improve the law—rather, they called them attempts to make it harder for many Americans to get or maintain coverage.

"There are ways we can strengthen and improve the law," Energy and Commerce ranking member Frank Pallone Jr., D-N.J., said. "However, I'm concerned that this hearing is taking a cynical approach to doing so. Rather than have a legislative hearing on bills that would help get more people health coverage, three of the bills being discussed today are designed to make it more difficult for people to get health care coverage."

Among the bills up for debate was a discussion draft from Rep. Bill Flores, R-Texas, to give people less time to repay late premiums before losing their coverage. Another from Rep. Marsha Blackburn, R-Tenn., would require people signing up for coverage during a special enrollment period, outside of the normal sign-up window, to prove their eligibility before receiving insurance. Currently, consumers can send documents after enrolling. A third, from Rep. Susan W. Brooks, R-Ind., would let insurers charge older Americans five times as much for care as younger Americans. Current law limits that ratio to three times as much, which can drive up costs for younger people while depressing costs for older people.

A bill from Rep. Rick W. Allen, R-Ga., would require audits for failed state insurance exchanges (HR 4262).

Republicans and insurance companies often say such lax policies allow people to game the system. They say loose rules governing special enrollment periods let people sign up for coverage only when they need it. Three-month grace periods for those who don't pay their premiums, as current law allows, let people stop paying their premiums for the last three months of the year, then sign up again during the next open enrollment period. And critics say limits on high costs for older people lead to higher premiums for young people—keeping them out of the exchanges and destabilizing the exchanges' risk pools.

Democrats, however, say requiring too much documentation under special enrollment could deter younger, healthier people from getting coverage during those times, leading only the sickest to persevere. They say grace periods aren't abused the way Republicans allege, and that expanding the age-rating bands will dramatically increase costs for older consumers—and simultaneously grow the law's subsidies for those Americans.

The committee also discussed one bipartisan bill, from Reps. Morgan Griffith, R-Va. and Diana DeGette, D-Colo., that would allow consumers to buy stand-alone dental plans for children inside and outside the exchanges (H.R. 3463).

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