Governors tell Senate committee they support state control, CSR payments and reinsurance

Five governors from both parties who spoke Thursday before a Senate committee on health support more state control to decide the course of insurance coverage in the individual market.

"Allow states more market power," said Democratic Gov. Steve Bullock of Montana.

"Gives back to the states the lion's share of responsibility," said Republican Gov. Gary Herbert of Utah.

[Also: Senate committee recommends extending cost-sharing reduction payments through 2018]

More than half of the states in the nation have filed or are about to file Section 1332 waivers to alter coverage requirements of the Affordable Care Act. The waivers allow states to waive the essential benefits to offer lower premium plans while maintaining protections for consumers with pre-existing conditions.

Massachusetts Republican Governor Charlie Baker told the Senate Committee on Health, Education, Labor and Pensions Thursday that his state is filing a 1332 waiver this week.

[Also: Fifteen states ask to intervene in CSR payment appeal over cost-sharing reduction payments]

Massachusetts joins 23 states that have begun steps towards getting a waiver, seven that have applied and two that have gotten waivers, according to Senate committee Chairman Lamar Alexander.

To stabilize the insurance market going into ACA open enrollment and a Sept. 20 deadline for insurers to finalize rates, Baker and other governors said they also support the continued federal funding of cost-sharing reduction payments to insurers for two years, not the one year suggested Wednesday by Alexander.

Insurers have said the continued funding of CSRs is necessary to keep the price of premiums from skyrocketing, and in some cases, is crucial to them remaining in the ACA market.

In Montana three insurers offer marketplace plans and all 56 counties are covered, Bullock said. Insurers are already working on 2019 rates.

"I'd love to see three years," Bullock said of CSR funding. "You're sending a message to the market that there's going to some stability there and they can plan accordingly."

If the CSRs aren't in place, insurers are going to have to change prices on their products and premiums will go up about 20 percent, Baker said. The federal government will end up spending the money through a shift in spending for advanced premium tax credits, he said.

Baker is the former CEO of Harvard Pilgrim Health Care and has been vocal in his views on healthcare policy in letters to Congress.

Colorado Democratic Colorado Gov. John Hickenlooper said the continued CSR payments were the most important consideration, followed by reinsurance.

The governors also voiced support to retain the reinsurance pool that pays money to plans that enroll higher-risk individuals.

Reinsurance, along with risk adjustment and risk corridors, were programs enacted under the ACA.

The governors who testified Thursday echoed some of the same concerns of state insurance commissioners who spoke on Wednesday over the need for stability in the insurance market.

The shifting of power from the federal government to the states is at the center of a last-ditch effort by Republican Senators Lindsey Graham of South Carolina, Bill Cassidy of Louisiana and Dean Heller of Nevada to give states block grants to set up their own programs, according to Politico.

The funding of Medicaid and consumer subsidies would be up to the individual state. It would also allows states to opt out of many ACA regulations, according to the Washington Post.

The president is behind the bill, according to Graham. Cassidy said the bill is still being refined but he hopes to have the text finalized this week, according to the published reports.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com