NASHVILLE — Tennessee Gov. Bill Haslam on Thursday urged Congress to "move quickly to stabilize" the nation's individual health insurance market and then mount "a serious effort" to curb soaring health care costs as federal lawmakers seek ways to keep the Affordable Care Act from imploding.
Joining four other governors to testify before the Senate Health Committee, chaired by Sen. Lamar Alexander, R-Tenn., Haslam, a Republican, said Congress "should take steps now to prevent the total collapse of the health insurance market."
Haslam and the other governors said that can be done by the federal government continuing to fund cost-share reduction payments that help subsidize insurance for low-income enrollees as well as by creating a short-term reinsurance program for enrollees to limit insurance companies' losses.
Another bipartisan plea from the governors: Provide more flexibility to states.
"All of us – Republicans, Democrats and independents – should agree that our current path is not a sustainable one," Haslam said.
Alexander is holding the hearings as Congress seeks a short-term fix to keep the Affordable Care Act, widely known as Obamacare, from melting down.
After that, Alexander said, Congress can then work on a longer term solution.
It all comes after GOP efforts to repeal former President Barack Obama's 2010 law, which extended health insurance coverage to millions of Americans, collapsed last month in the Senate.
President Donald Trump, meanwhile, has threatened to end the estimated $7 billion or so in special federal cost-sharing reduction payments that enable lower-income Americans to pay for insurance on the health care exchanges.
At the same time, a number of Obamacare insurers have dropped out of providing health coverage in states across the country. It's a major problem in Tennessee, where most counties only have a single insurer participating in the exchanges.
Alexander said he hopes to find and pass a temporary patch by the end of September with an eye toward later taking a more comprehensive approach on an issue that has bitterly divided majority Republicans and minority Democrats since the 2010 law was first conceived and passed by Democrats.
The chairman said he hopes to release a bipartisan bill within 10 days or so.
"Our goal is to get a result in a very short period of time on a 2018 stabilization package that is small, bipartisan and balanced," Alexander said as he convened Thursday's hearing, the second of four hearings planned.
He said he is "looking for a way to get a result and it's easy to discuss extending cost sharing payments." But Alexander said there is "no chance of getting that unless we have some restructuring of the market."
A former governor, Alexander showed particular interest in states pursuing special Section 1332 "innovation" waivers allowed under Obamacare.
According to the National Conference of State Legislatures, the waiver allows a state to seek to restructure provisions of the health law to fashion a coverage system that better meets local needs and preferences while still fulfilling the aims of the ACA.
A few states have obtained the waivers. Alexander said the waiver has his interest "because it's already in the law" and he believes restructuring will offer states help.
But Alexander warned that to "get a Republican president and a Republican Senate to vote for more money just won't happen."
The Section 1332 provision currently requires state legislative approval, but Alexander said that to move quickly it could be changed to let governors or insurance commissioners apply.
Alexander pointed to actions taken by Alaska which used a Section 1332 waiver to create a state-operated fund. It covers health care costs of people in the individual insurance market that had costly diagnoses.
According to a July news release from Alaska Gov. Bill Walker's office, the program uses federal money to re-insure claims for Alaskans with high-cost medical conditions. That reduces premiums for all of the roughly 23,000 Alaskans in the individual market.
Alexander suggested states be able to fund such programs themselves. He urged governors to get back to him with specific ideas on that and other fixes by Wednesday, cautioning that "this train may move through the station" quickly.
Haslam and fellow Republican Govs. Haslam and Charlie Baker of Massachusetts and Gary Herbert of Utah as well as Democratic Govs. Steve Bullock of Montana and John Hickenlooper of Colorado presented a mostly united front in urging action from Congress.
"It's time for the federal government to work with us, not against us," Hickenlooper said. "Without your help it's like climbing one of your Colorado's famous 14,000-foot mountains in winter without a parka or crampons [foot traction device]. It can't be done. We need immediate federal action."
Gov. Herbert of Utah said "states are better able to address these issues for their unique populations and unique demographics than the federal government that is too often trapped in a one-size-fits-all mentality."
He also stressed that "it would be irresponsible to allow these markets to collapse simply because of political paralysis or inaction."
Haslam and the other governors also called for creating the reinsurance program that would limit losses to marketplace insurers. They also are seeking more flexibility to create and oversee insurance plans that are more in synch with individual states' needs.
Chairman Alexander noted that Tennessee Insurance Commissioner Julie Nix McPeak testified before his panel on Wednesday that the state's "individual market is "very near collapse."
For example, Chattanooga-based BlueCross BlueShield of Tennessee withdrew not just from providing the subsidized insurance but from the individual market entirely in Knoxville, Nashville and Memphis. The insuror later agreed to remain in Knoxville for 2018.
If Congress doesn't pass a short-term fix by the end of September, Alexander said, "up to 350,000 Tennesseans and millions of Americans could be literally left with zero options to buy insurance in the individual market."
But if lawmakers can forge a bipartisan solution, Alexander said, "we can limit increases in premiums in 2018; continue support for co-pays and deductibles for many low-income families; make certain that health insurance is available in every market and lay the groundwork for future premiums decreases."
According to McPeak's office, an estimated $190 million is now spent in Tennessee on cost-sharing subsidies for Tennessee enrollees. There are some 155,747 enrollees in Tennessee who receive subsidies. That represents 58 percent of the marketplace. Some $1,222 spent annually per qualifying enrollee.