Alexander-Murray ACA Market Stabilization Bill

The Affordable Care Act (ACA) created cost-sharing reductions (CSRs) to compensate health insurers for offering plans to low-income individuals that impose lower cost-sharing requirements. As the result of an ongoing lawsuit alleging that the ACA did not formally appropriate funding for this program, the Obama Administration voluntarily made these payments. On October 12, President Trump announced that he intended to cease making payments for CSRs, leaving many concerned as to the effect it would have on the stability of the ACA-created marketplaces. On October 17, following a series of hearings in September and October with testimony from various stakeholders, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) released draft legislation that would provide a short-term appropriation of CSR payments.

View APA's Letter to Senators Alexander and Murray

The Murray-Alexander bill contains numerous provisions that would have an impact on the ability of individuals to access treatment of mental illness and substance use disorders. They are summarized below:

  1. Appropriates CSR Funding
  2. Increased Funding for ACA Enrollment Outreach and Assistance
  3. Accelerates Section 1332 Waiver Process
  4. Allows Broader Enrollment in Catastrophic Plans

CSR Funding

  • Appropriates funding for CSR payments. The bill formally appropriates funding for CSR payments for plan years 2017, 2018, and 2019, essentially taking the decision to make these payments out of the hands of the Administration.
  • Imposes additional oversight and reporting requirements. The bill contains optional language that, if it ends up in the final version of the bill, would require state insurance commissioners to develop a plan to ensure that CSR payments have a direct financial benefit to enrollees and the federal government.

ACA Enrollment Outreach and Assistance Funding

  • Increases funding for enrollment outreach and assistance. The ACA created a program that offers grants to a variety of organizations to: (a) raise public awareness of the ACA marketplaces via public outreach campaigns; and (b) provide direct enrollment assistance to individuals. This bill increases funding for these grants for plan years 2018 and 2019, but also imposes additional data-collection, reporting, and oversight responsibilities on the federal Department of Health and Human Services to measure the effectiveness of these grants.

Section 1332 Waivers

  • The ACA created a process by which states could develop innovative models of insurance coverage that would provide the same benefits to enrollees at a lower cost. However, the ACA imposed stringent requirements on these programs, and very few state applications for these waivers were approved.
  • The bill maintains the core requirements that plans offered under Section 1332 waivers as to mandatory coverage and essential health benefits. However, the bill alters the Section 1332 waiver process in several ways, including:
    • Shortens the approval period from 180 days to 90 days;
    • Creates a shorter approval process for 1332 waivers submitted to remedy “urgent situations” where states experience excessive premium increases or have no plans offered in the ACA marketplace;
    • Extends the life of these waivers to from five to six years and allows for unlimited renewals;
    • Eliminates the requirement that state legislatures must pass a law approving a Section 1332 waiver, and instead allows Governors to approve a Section 1332 waiver;
    • Changes the requirement that Section 1332 waiver programs offer coverage “at least as affordable” as marketplace plans to coverage “of comparable affordability” to marketplace plans.

Other Insurance Marketplace Changes

  • The ACA allowed individuals under age 30 to purchase “catastrophic plans” that offer the same essential health benefits, but only after a relatively large deductible is fulfilled. This bill would allow individuals of all ages to purchase these plans.
  • Directs the Administration to issue regulations on interstate health compacts that would allow plans to be offered in markets across multiple states.