WASHINGTON — President Trump says Republicans should let the Affordable Care Act collapse. Republican Senator Susan Collins has an opposite point of view: shore up the ACA to stabilize health insurance coverage for millions of Americans who need help.
In an interview this week after she played a key role in scuttling Senate GOP efforts to repeal the law, commonly known as Obamacare, the Maine moderate called for a bipartisan congressional effort to bolster payments offered to insurance companies that sell coverage on the ACA’s state-by-state health care exchanges.
She predicted enough Democrats will want to protect consumers from losing coverage that they will overcome partisan hostilities and work with the GOP majority to keep the money flowing.
If the insurance company payments are cut off, which Trump has threatened to do, advocates fear more insurers will withdraw from local insurance markets around the country. The payments help insurance companies cover the costs of deductibles and co-pays for low-income people.
“There are members on both sides of the aisle that do not want to see a bipartisan bill that improves the ACA. But my hope — and I really hope I’m right about this — is that the majority do want to get to yes,” Collins said in an interview with the Globe Tuesday night. “There’s a strong incentive for the Democrats because otherwise the markets are going to collapse in several states with Democratic senators, so I think that will be motivation for even those that might not want to see a bipartisan bill.”
Collins is positioned to be a key player on a bipartisan fix, should one get off the ground. She is a member of the Senate Health, Education, Labor, and Pensions Committee, which would take a lead role. She said the panel’s chairman, Lamar Alexander of Tennessee, “wanted to stay very close to me on the issue and get my input.”
Of course, her own party’s leadership must get on board as well.
Majority leader Mitch McConnell earlier Tuesday said “we’ll have to see” when asked about moving forward on legislation with Democrats. Trump said he was inclined to “just let Obamacare fail,” before announcing plans to invite the full 52-member Senate GOP caucus over to the White House for lunch Wednesday to try to figure out a path forward.
The government payments to insurers to help with deductibles and co-pays are a source of deep uncertainty in the individual markets. House Republicans in 2014 sued the Obama administration and won in lower court arguing the payments were illegal because Congress didn’t appropriate the funds. The Trump administration has so far kept up the payments, but losing them, experts say, would cause insurers to exit the marketplaces and millions of Americans to lose coverage.
Doubt over Trump’s commitment to the payments of is one reason markets have been so fragile, with some counties having all insurers exit the ACA marketplaces — a situation Collins described as a “spreading crisis.”
“It bothers me when I hear people describe that as a bailout for the insurers,” Collins said of guaranteeing the payments, nodding to the way some of her Republican colleagues describe the payments — including John Cornyn of Texas, the No. 2 Senate GOP leader.
“The reason those exist, the cost-sharing reductions, is that otherwise very low income individuals — below 250 percent of the poverty rate — would not be able to afford their deductibles and their co-pays, and if you have an insurance policy with a deductible that’s so high that you can’t afford it . . . then you don’t really have insurance. So I see those cost-sharing reductions as being vital to helping some of the most vulnerable, low-income people who are benefiting from the Affordable Care Act.”
Another ACA issue Collins wants to fix are so-called cliffs in income limits that determine if an individual consumer qualifies for government subsidies for insurance premiums. Under the current rules, if people make $1 above an income limit, they lose their subsidy, which is particularly tough for Maine’s many self-employed residents, who may not know exactly how much they will make in a particular year, she said.
Another proposal Collins would like to see in a bipartisan bill: provisions designed to spur greater competition in the pharmaceutical market. Bringing down high drug prices is a cause that Trump has embraced from time to time. It’s a favorite of many on the left as well, including Vermont Independent Bernie Sanders. Collins pointed to legislation she has cosponsored with Democratic Senator Claire McCaskill of Missouri that seeks to make it easier for generic drug makers to enter the market, a reaction to the spate of cases of hedge fund-like firms buying up patents on older drugs, then jacking up their prices.
“That’s an area where I think I can work well with the administration,” she said.
Despite the speculation that Democrats will remain on the sidelines for political gain ahead of the 2018 midterms, Collins said in private conversations with her Democrats have admitted there are serious problems with the ACA, “but they were so worried about the entire law being unraveled — and understandably so — and deep cuts in Medicaid being imposed . . . that they didn’t want to engage. Now I’m finding that they seem ready to engage.”