Republicans don’t get it, Democrats don’t get it, the structure of cost shifting in the ACA can’t be sustained. Affordable you say?

What they are talking about is the provision in Obamacare that subsidizes the co-pays and deductibles for lower income Americans. But the money hasn’t been flowing to insurers thereby driving up premiums. When will they learn health insurance premiums are actually driven by the claims paid. 

Alexander has been floating the notion of guaranteeing insurance companies that they would be reimbursed for at least one more year for the “cost-sharing reduction” discounts they provide to enrollees with incomes under 250 percent of the federal poverty level. Insurers must make those payments under the Affordable Care Act, but the Trump administration has threatened to withhold the money owed insurers.

Commissioners said insurers in their states plan sharp rate hikes next year unless Congress removes that uncertainty by appropriating money to pay the discounts, estimated at $10 billion in 2018.

In exchange for guaranteeing the cost-sharing payments, which Democrats have sought, Alexander suggested Democrats would need to give states more flexibility to seek waivers from the rules of the federal health law to experiment with different ways to provide health insurance coverage. “Democrats will have to agree to something they may be reluctant to support,” he said. “That is called a compromise.”

But the state insurance officials — Democrats and Republicans from Tennessee, Alaska, Washington, Oklahoma and Pennsylvania — agreed that the guarantee for funding cost-sharing payments needs to go for more than a year. Source: Kaiser Health News


  1. ACA is like the tire I had on my bike when I was a kid. Every morning when I was ready to ride I found it had a flat. Every morning I patched the tube. Eventually I figured out that I needed to get a new tube because all those patches weren’t the answer.


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