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Alexander wants bipartisan Obamacare ‘fix’ by end of next week. "Timing is a challenge," Senate Health, Education, Labor, and Pensions Committee chairman Lamar Alexander said in his opening remarks for the first hearing on stabilizing Obamacare held on Wednesday. "So I propose that we come to a consensus by the end of next week when our hearings are complete so that Congress can act by the end of September.” Alexander, R-Tenn., said that a small and narrow package to stabilize Obamacare's markets is the best way to end a stalemate between Republicans and Democrats over healthcare that has endured since Obamacare's passage. But the length of a stabilization package has already emerged as a major sticking point to the Senate's nascent efforts at bipartisanship. Alexander — chairman of the Senate Health, Education, Labor and Pensions Committee — is working with ranking member Sen. Patty Murray, D-Wash., on a stabilization package for Obamacare's exchanges for 2018. Alexander said that the package is likely to be narrow, hinting on Tuesday that it could just include giving states more flexibility to get federal waivers for changes to their healthcare market and providing funding for cost-sharing subsidies to insurers for 2018. "We will see if we can come up with a limited bipartisan package, maybe just two things that have some effect in 2018," Alexander said. He is in favor of funding the cost-sharing subsidies, which pay insurers for lowering out-of-pocket costs for low-income Obamacare customers, for just 2018. He didn't say, however, if he would be in favor of funding them beyond 2018.

What health insurers and health groups want Health insurers and medical groups like the American Hospital Association are asking Congress to appropriate two years of cost-sharing reduction subsidies, even as Republicans and Democrats have indicated that there is disagreement over whether to appropriate the funds at all, though it’s being considered by members of the HELP committee. America's Health Insurance Plans, the group making the request, in prepared statements, asked Congress to undo the health insurance tax, as well as for a federally funded reinsurance program. Insurers voiced their support for a GOP proposal that would give states more flexibility over 1332 waivers under Obamacare, known as "innovation waivers." AHIP specifically requested that waivers take less time to be approved by the administration, rather than the 180 days stipulated in the law, and that state officials be allowed to bypass their legislatures in cases of an emergency.

Insurance regulators want reinsurance funding A majority of insurance regulators testifying at the Senate HELP hearing asked Congress to approve money for reinsurance programs, which Republicans are reticent to approve. “A $15 billion reinsurance program in the context of a careful, bipartisan approach to improving our healthcare system would be something I would view favorably,” Pennsylvania Insurance Commissioner Teresa Miller said at the hearing on Wednesday. At the hearing four out of the five insurance commissioners openly called for reinsurance funds, which help pay insurers with the sickest claims. So far Republicans haven’t endorsed adding reinsurance funding for the stabilization package, opting instead to go with funding insurer subsidies for 2018.

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Murray lays out proposal for Obamacare stabilization package, including priorities that differ from Alexander. Murray said in a Washington Post editorial published the day before the hearing that she wants a "multi-year solution to offer certainty to patients and families and to truly help prevent premium increases." She also wanted to go much further than Alexander's two items. She called for adding a public option that provides government-run health plans on Obamacare's exchanges and funding for reinsurance, which gives payments to Obamacare insurers with the sickest enrollees. If the Senate can reach agreement, then Alexander hopes to get something passed out of the upper chamber by the end of the month and added he hasn't talked with anybody in the House. Senate HELP is holding a series of hearings starting today on the individual market and how to stabilize it. In her prepared statements she said she supports a reinsurance package. "I think we're all aware threading this needle won't be easy," she said. "But I do believe an agreement that protects patients and families from higher costs and uncertainty, and maintains the guardrails in our current healthcare system, is possible."

Paul: Lets get people out of the individual market Sen. Rand Paul, R-Ky., made an unorthodox pronouncement during the HELP hearing Wednesday. He said that it might be impossible to fix the individual market. “We’re subsidizing an individual market that just does not work,” he said. “Lets not try to fix the individual market, Let’s try to give people an exit ramp to get out of the individual market completely.” Paul called for association health plans instead that lets individuals and employer groups band together to buy insurance. He has called for association health plans before in separate Obamacare repeal plans. But experts question the health plans. The American Academy of Actuaries reported that such association health plans could bypass coverage protections. “In particular, if an AHP is allowed to follow the issue, rating, and benefit rules of a single state nationwide, or be pre-empted from state regulation by being self-insured, it would impose different rules on insurance providers offering coverage in the same market,” the report said. “The viability of many state-based markets would be challenged as a result.”

Johnson reiterates support for funding CSRs Over at a hearing held by the Senate Committee on Homeland Security and Governmental Affairs, Sen. Ron Johnson, R-Wis., a key conservative, said he thought Congress should fund the payments, pointing out that the government would otherwise pay more through premium subsidies. He did not say how long he wants the funding to be appropriated. 

Freedom Partners releases ad opposing more funding for Obamacare. A new digital ad from the group, funded by the conservative Koch brothers, discourages efforts to inject more federal funding into Obamacare. It highlights double-digit rate requests in various states and calls the funding a “bailout.” “The billions in taxpayer handouts that have propped up Obamacare for years have resulted in fewer choices and an average individual premium increase of 105 percent,” Freedom Partners Vice President of Policy Nathan Nascimento said in a statement. “Squeezing more money out of Americans to continue subsidizing a law that’s hurting them is indefensible – it’s time for real solutions that provide real relief.”

Cassidy and Graham continue to push their repeal bill. Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana returned to Washington Tuesday saying that they still had hope that an amendment they are working on could act as a vehicle to repeal and replace portions of Obamacare. The amendment, which has not been fully written and has not been scored by the Congressional Budget Office, would transfer Obamacare's revenue from taxes to states so they can come up with their own plans. Graham has said previously that he believes as much as $500 billion could be sent to states. "I've never felt better about it," Graham said about the amendment. "It ain't done yet but we're getting there." Rep. Mark Meadows, chairman of the Freedom Caucus, which helped negotiate a House bill to repeal and replace portions of Obamacare, told reporters Tuesday that he supports the Senate trying again to repeal portions of Obamacare, and doing so through Graham-Cassidy. The deadline for doing so through reconciliation, which allows a bill to get passed in the Senate by only 51 votes instead of 60 needed to break a filibuster, runs out Sept. 30.

A bill by any other name? Graham corrected a reporter on Tuesday when he asked how Cassidy-Graham was progressing. “You mean Graham-Cassidy,” he said. Cassidy has corrected reporters to say it’s the other way around, though he called it “Graham-Cassidy” in the HELP hearing Wednesday.. It’s actually Cassidy-Graham-Heller. Sen. Dean Heller, R-Nev., signed on to the proposal a few weeks after it was unveiled by Graham and Cassidy. So Cassidy and Graham sometimes do remind reporters that Heller is a co-sponsor too when they are asked for an update on “Cassidy-Graham.”

Major doctors group: Ending DACA could exacerbate doctor shortages. The biggest doctor group in the country said President Trump's decision to phase out the Deferred Action for Childhood Arrivals program could lead to crippling doctor shortages.The American Medical Association said the nation's healthcare workforce depends on international medical graduates, which now account for one out of every four physicians practicing in the U.S. "These individuals include many with DACA status who are filling gaps in care," the AMA said in a letter to House and Senate leadership. Trump decided to phase out the program after six months, putting the onus on Congress to create new legislation.

Anti-abortion groups renew call for defunding Planned Parenthood. The 10 groups wrote to Congressional Republicans on Tuesday calling for them to use a procedure called reconciliation that lets a bill get passed in the Senate by only 51 votes instead of 60 needed to break a filibuster. "The pro-life majority that now controls both chambers of Congress and the White House must pass a reconciliation bill stopping the vast majority of federal funding for Planned Parenthood," the letter said. "Doing anything less brings into question whether this Congress can truly be called the Pro-life Congress." Obamacare repeal was originally intended to defund Planned Parenthood, but repeal is at a standstill after a failed Senate vote in July. Now Congress has until the end of the month before the original budget resolution expires. The groups are calling on Congress to pass a reconciliation bill that stops federal Medicaid funding to the women's health and abortion provider. "Should robust efforts on the [fiscal year] 2017 reconciliation bill run out of time, then the fight to defund Planned Parenthood must move immediately to the [fiscal year] 2018 reconciliation bill," the letter said.

Studies: Narrow network plans are roughly 16 percent cheaper than plans that have broader networks. In the September issue of Health Affairs, published online Tuesday, several studies assessed the impact of narrow networks, which insurers use to negotiate lower prices with doctors and hospitals. One study found that these networks can reduce premiums for customers by between 6 and 9 percent. Authors of the study estimate that premiums would have cost 10.8 percent more in 2014 if insurers had used broader networks. These arrangements, however, can raise concerns about other costs. For instance, patients may not be able to reach a wide-array of care in a timely manner. A second study found that most plans on the federal exchange covered at least quarter of physicians in an area, and that these networks remained stable from 2015 to 2016. “From a policy perspective, the standards in place regarding network adequacy remain relatively vague,” the authors concluded. “Improving our ability to interpret, implement, and enforce these standards will be critical no matter what the future holds for the ACA and related policy.” A third study found that mental health networks were more narrow than those for primary care.

RUNDOWN

Axios The infant mortality problem by race and geography

The Hill MacArthur and Freedom Caucus reach deal in principle on Obamacare fix

STAT News IBM pitched Watson supercomputer as a revolution, it’s not even close

Washington Post Immigrants’ healthcare problems are about to get worse

NPR Kentucky could become the only state without a clinic that performs abortions



Calendar

CALENDAR

WEDNESDAY | Sept. 6

Noon. Cato Institute. 1000 Massachusetts Ave. NW. Discussion on “The Long-Term Effect of Health Insurance on Near-Elderly Health and Mortality.”  Details.

THURSDAY | Sept. 7

Sept. 7-8. Ronald Reagan Building. 1300 Pennsylvania Avenue NW. Medicare Payment Advisory Commission public meeting. Details.

9 a.m. National Press Club. 529 14th St. NW. National Survey on Drug Use. Details.

9 a.m. 216 Hart. The Senate Health, Education, Labor and Pensions Committee will hold a second hearing on stabilizing the Obamacare exchanges, with several governors testifying. Details.

10 a.m. 215 Dirksen. Senate Finance Committee hearing on CHIP reauthorization. Details.

10:30 a.m. 106 Dirksen. Senate Appropriations Committee markup of HHS spending bill. Details.

11 a.m. Newseum. 555 Pennsylvania Ave. NW. Research!American discussion with federal agency officials on “Is a Disease-Free World Within Reach?” Details.

FRIDAY | Sept. 8

9:15 a.m. AEI. 1789 Massachusetts Avenue NW. Govs. John Hickenlooper and John Kasich discuss bipartisan proposal to stabilize health insurance market. Details.

Noon. G50 Dirksen. Alliance for Health Policy discussion on “Stabilizing the Individual Market in Uncertain Times.” Details.

TUESDAY | Sept. 12

10 a.m. 420 Dirksen. The Senate Health, Education, Labor and Pensions Committee will hold a third  hearing on stabilizing the Obamacare exchanges, with discussions on state flexibility. Details.

2:30 p.m. Brookings. 1775 Massachusetts Ave. NW. Event on “Inclusive School Environments: Improving Outcomes for Students With and Without Disabilities.” Details.