Can Alexander-Murray proposal survive Trump ?

In the none too distant past, it was assumed that the Affordable Care Act was doomed, then it seemed to get a life support, of sorts, from the defeat of the Graham-Cassidy bill, and then with the near certain defeat of the proposal by Sens. Lamar Alexander and Patty Murray that wanted to provide continued subsidies for insurers with low-income beneficiaries, it was anyone’s guess to what the future held. Then lo and behold, out of the ashes, on Tuesday, appeared a victory for an agreement to do just that, and then nearly a day later news reports from Washington, said that the latter had the support of 24 senators, 12 Democrats and 12 Republicans.

That took some surprise from political pundits, on both sides, quickly followed by condemnation from President Trump who exclaimed loudly that the deal was done, and over with - finito, dead. But, in a blink of an eye, after encouraging the pair he denounced it again, as did other who called it a bailout for the insurance industry -- a full loaded term across the nation, used to condemn school systems in the urban midwest, and in recession America, for car companies, gasping for air.

“President Trump's mixed messaging is increasingly throwing a curveball into negotiations on Capitol Hill, leaving lawmakers struggling to keep up with his changing opinions,” reported The Hill.

They also noted, that “It was just the latest example in what’s become a familiar cycle on Capitol Hill: Senators believe they and Trump are on the same page, only to find out — sometimes hours later and frequently through tweets — that the president has changed his mind.”

Defeating President Obama’s signature legislation became an almost mythic mating call for the GOP and the repeated failures have left Congress and the Trump base in a headlock, of sorts, as no one can see which direction the wind may blow, and how often the president tweets in the wee hours, to add spice, some say madness, to the whole affair of governing.

The Alexander-Murray proposal is to give two years worth of subsidies to insurance companies for their low income beneficiaries to help pay for deductibles, co-pays and other out of pocket costs, and to defray the cost of insuring them.

Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), respectively the chairman and the top ranking Democrat of the Senate Health, Education, Labor and Pensions Committee, also against hard opposition, feel that, as the pressure mounts they can pass it by the end of the year, while others are not so optimistic.

Critics note that the proposal, even it becomes law may not undo the damage already done to the the ACA, colloquially known as Obamacare, especially in the light of reduction in advertising by 90 percent, and neighborhood navigators, by nearly one-half; these are trained personnel to help signup new enrollees in public access venues, such as libraries.

“From what I’m hearing on the Alexander-Murray deal, it is good news for insurers and consumers and could mitigate some of the damage done by the Trump administration,” said Emily Gee, a health economist at the Center for American Progress, a left-leaning think tank in D.C.

“However, this open enrollment still remains an uphill battle. Recent polling reveals there’s a great deal of confusion about the marketplace among current enrollees and potential consumers, much of which has been stirred up by the administration’s campaign against the ACA, and any deal can’t change that overnight,” she said.

That is a huge problem for those responsible for educating the public and for consumers, both new, and former, enrollees to know that they can get health coverage.

In a media briefing on Wednesday, the Kaiser Family Foundation gave the not-so- encouraging results of a poll that showed only 33 percent of potential enrollees in individual market know that open enrollment begins Nov.1, and perhaps the most shocking result, that 30 percent of those polled thought that the individual mandate was not in effect, or did not know that it was.

Of utmost importance for consumers is that insurers are still required to provide

reduced deductibles, and copays for low-income marketplace enrollees; and secondly that while insurers are increasing premiums to offset the loss of payments from the federal government, consumers will mostly be held harmless.

Cost sharing reductions (CSR) - subsidies - are available to eligible individuals in the marketplace with income 100 percent to 250 percent of the federal poverty level: $12,060-$30,150 for individuals in 2018, and  $24,600 to $61,500 for a family of four in 2018.

Nationwide, 57 percent of marketplace enrollees were eligible for CSR in 2017 and in states that did not expand Medicaid, on average two-thirds of marketplace enrollees had CSR in 2017.

Adding to another public misunderstanding is that open enrollment for 2018 will be shorter in most states from November 1 through December 15, 2017 in the Healthcare.gov states; and that it will be 6 weeks, compared to 12 weeks in prior years.

Equally important for consumers is to be aware that state run marketplaces have an option to extend dates, and many have.

Of course, the White House has used this lack of knowledge by the public to their advantage, and perhaps the biggest myth, or misinformation, they have promulgated is that insurers are getting rich on these subsidies, when in fact they are getting reimbursed for monies that they have already paid. Trump, in fact, inflated insurance company stock prices from 2010, and not when the provisions took place, in 2014.

“I am very concerned that the president’s actions have confused people, along with all of the conversation around the attempts to pass the two versions of Trump Care we saw earlier this year,” said Sen. Maggie Hassan (D-N.H.).

Piggybacking onto that are further myths surrounding the exodus from the ACA on the exchanges, in shock and awe to show that the ACA was an abject failure, when in fact, it actually happened because many insurers set premiums too low in anticipation that there would be a much higher level of younger enrollees; subsequently it was mostly sick, or older enrollees that signed up.

The path for the Alexander-Murray bill to become law is paved with good intentions, but faces a perilous path of opposition from people such as Speaker of the House Paul Ryan who wants to obliterate Obamacare, to support from old time GOP leaders such as Susan Collins of Maine and John McCain of Arizona, to Lisa Murkowski of Alaska who gave the thumbs down to the Graham-Cassidy bill. Of note is that they are now also on the list of co-sponsors .

Getting the bill to the floor is the last battle, and there are some that think that the best chance of success is to attach the proposal to a spending bill  But, for the 18 million Americans who get their health care on the individual market, time is of the essence.