The month of September has been bombarded with health care bills. This week alone, Democrat and Republican senators introduced both a single-payer plan and an Affordable Care Act (ACA) repeal and replacement plan. But the most important bill has yet to be released. Language to the only health bill that’ll immediately secure the ACA marketplace and relieve nearly 22 million people of stress next year — and a host of coverage providers — will be released soon.

The last of four hearings held by the Senate’s Health, Education, Labor and Pensions (HELP) concluded Thursday. After listening to testimonies from governors, insurance commissioners, and health care stakeholders more broadly, the HELP committee is writing legislation, slated to be released next week.

The bill — as promised by HELP Committee Chairman Lamar Alexander (R-TN) — will be slim, per passing legislation without political game. Lawmakers are pressed against a hard deadline of September 27, when insurers have to sign final contracts for selling on the 2018 ACA marketplaces.

The bill will likely include three legislative items:

Committing to pay cost-sharing reduction subsidies to insurance companies for at least a year Letting older people on the marketplace buy catastrophic plans, which are cheap premium plans with high out-of-pocket costs. Changes to state innovation waivers


The first policy is largely uncontroversial, and every expert that has testified before the Senate HELP committee over the last two weeks has said the federal government should commit to paying these CSR payments. CSR payments are important because they’re one of two subsidies available to low-income people who receive coverage through the ACA. The other is tax credits, which everyone isn’t eligible for. President Donald Trump has been deciding whether or not to make CSR payments to insurers on a month-to-month basis, which has ridden stakeholders with anxiety. Without payments, premiums on average would increase about 20 percent. (However, most ACA enrollees will be safeguarded due to subsidies.)

But the first point will only pass if Democrats swallow a few Republican ideas. That includes the second point: making catastrophic plans available to older people on the marketplace.

Through committee hearings, Sen. Alexander has said members cannot just “throw money” at the ACA because there are structural problems with how the marketplace operates. In some states, the marketplace is in bad shape. Currently, 63 Virginia counties do not have any insurers signed up to sell plans next year. Additionally, about 28 percent of ACA enrollees live in counties that are projected to have only one participating insurer next year — that’s about 2.6 million consumers, according to the Centers for Medicare and Medicaid Services.

Health experts have largely said that so-called copper plans, or catastrophic plans, would do little — if nothing — to shore up the marketplace. GOP members continue to argue that people just need more low cost options to enroll in the marketplace. A similar plan, with low premiums and high out-of-pocket costs, already exists on the marketplace.

The last big thing to watch for next week is changes made to state innovation waivers. Depending on how the language is changed to the existing waiver, consumer protections could take a hit at the expense of state flexibility.


What is clear is that lawmakers, for the most part, are just happy that hearings on health care are happening. As such, members in the House are trying to prompt their own ACA hearings.

“I think the Republicans — the serious ones — know that you got to create market stability or we will have repercussions across the market,” Rep. Ami Bera (D-CA) told ThinkProgress when asked if this week’s bill dump would distract from ACA stabilization talks. “And everyone will see premiums go up.”

Thirty-eight House members of the New Democrat Coalition, including Rep. Bera, sent a letter to Sen. Alexander and HELP committee ranking member Patty Murray Friday, thanking them for holding hearings. In the letter, House members listed some of their own ideas, one of which is sure to make it in the Senate bill: paying CSR payments to insurance companies. When asked if New Democrat Coalition members could sign off on a Senate bill that includes Republican ideas like copper plans, Bera said there’s “openness.”

Alexander told reporters Thursday that after this bill is passed, his committee will not be turning to long-term bipartisan ACA reform, but instead look at health care costs more broadly. The ACA only accounts for about 7 percent of the total health care market.