Just a few weeks ago, the Affordable Care Act stabilization bill from Sens. Lamar Alexander and Patty Murray looked like a common-sense fix with a decent shot at finding its way into Congress’ big end-of-the-year package. But that was before Republicans were on the cusp of repealing the individual mandate. Now the bill’s constituency is eroding — on every front.
I asked several of the smartest experts around whether they’d rather enter this new reality with or without Alexander-Murray. They were unanimous — they’d rather take their chances without it, keeping higher premium subsidies instead.
Democrats liked Alexander-Murray on its own, but Sen. Susan Collins is now framing the bill as a trade-off to help her support repealing the law’s individual mandate, and Democrats can’t go for that deal. Many Republicans never supported Alexander-Murray. The Wall Street Journal reports that it won’t be attached to the two-week spending bill Congress takes up this week, and that House Speaker Paul Ryan was never part of any agreement to pass the bill to help get Collins on board with Republicans’ tax overhaul.
Independent experts are also souring on the proposal. “I don’t think it’s good policy,” said Duke researcher David Anderson. He’s been beating this drum for a while, and more analysts are starting to agree with him. Here’s the argument: President Trump’s decision to cut off the ACA’s cost-sharing payments ended up artificially inflating the ACA’s premium subsidies, to an extent many experts simply hadn’t anticipated. For many people who get those subsidies, insurance is more affordable now than ever before.
Undoing Trump’s actions through Alexander-Murray would also undo that subsidy bump. And experts increasingly think that’s not worth it. “The current setup is weird, and I think that kind of offends some people’s sensibilities. But it’s working, so I don’t think there’s a compelling need for Alexander-Murray right now,” the Kaiser Family Foundation’s Larry Levitt said.
Everyone agrees that repealing the individual mandate will lead to higher premiums and probably less competition among insurers. No one is quite sure how bad those effects will be, which makes it hard to say for sure how much Alexander-Murray would help or hurt. But given the choice, experts say they’d rather try to figure out a post-mandate world without Alexander-Murray than with it.