A group of 11 states and the District of Columbia running their own Obamacare exchanges want more federal funding to stabilize exchanges facing higher premiums and insurer defections.
The states wrote to leaders of the Senate Health, Education, Labor and Pensions Committee with their ideas on Tuesday. Those include guaranteeing insurer payments and establishing a permanent reinsurance fund to help insurers.
The HELP committee has scheduled hearings next week on market stabilization in an effort to reach a bipartisan deal to prop up Obamacare's markets for next year.
Currently, 39 states use the federally run healthcare.gov for residents to sign up for Obamacare plans. The remaining 11 states and the District of Columbia run their own exchanges.
The exchanges point to several ideas to stabilize the exchanges. Chief among them is guaranteeing cost-sharing reduction payments to insurers that reimburse them for reducing co-pays and deductibles for low-income Obamacare enrollees.
Another idea is to establish a permanent reinsurance program. Under the program, insurers with higher-cost enrollees would receive payments to help offset the cost and thus lower premiums.
While states say that they receive get a waiver to set up their own reinsurance program, they are worried about shouldering any of the cost.
"Many states have budget constraints that limit their ability to dedicate a sufficient and ongoing stream of state funding to support a state-level reinsurance program or to match a state-federal reinsurance program," the letter said.
A federally funded program could provide a consistent solution for providing stability, the exchanges say.
The states also want the Department of Health and Human Services to continue pursuing additional flexibility in granting them federal waivers. The 1332 waivers are intended to give states more flexibility to meet Obamacare's requirements.
Beyond 2018, the exchanges want the Trump administration to continue funding marketing and outreach for Obamacare. Some advocacy groups and Democrats have criticized the Trump administration for curbing outreach to Latinos.
The plea for changes comes as insurers are trying to figure out how much to charge for Obamacare. Some states have seen proposed rate increases of more than 50 percent and exchanges have seen insurers defect because of mounting losses and questions about the future of the cost-sharing payments.
While every county will have an insurer offer coverage next year, concerns still remain about prices and consumer choice for plans.