HEADS UP! House E&C Committee to hold hearings on 3 "mini ACA 2.0" bills this week!


I don't know what the status is of H.R. 5155 (the House Democrats catch-all "ACA 2.0" bill which I've been pushing for awhile now), but it looks like individual elements of it are also in the works as standalone bills:


Date: Wednesday, March 6, 2019 - 10:00am
Location: 2123 Rayburn House Office Building
Subcommittees: Health (116th Congress)

The Health Subcommittee with hold a legislative hearing on Wednesday, March 6, at 10 am in the John D. Dingell Room, 2123 Rayburn House Office Building. The hearing is entitled, “Strengthening Our Health Care System: Legislation to Lower Consumer Costs and Expand Access.” The bills to be the subject of the legislative hearing are as follows.

H.R. 1425, the “STATE HEALTH CARE PREMIUM REDUCTION ACT”, introduced by Reps. Angie Craig (D-MN) and Scott Peters (D-CA), would provide $10 billion annually to states to establish a state reinsurance program or use the funds to provide financial assistance to reduce out-of-pocket costs for individuals enrolled in qualified health plans. The bill also requires the Centers for Medicare and Medicaid Services (CMS) to establish and implement a reinsurance program in states that do not apply for federal funding under the bill.

H.R.1386, the “EXPAND NAVIGATORS’ RESOURCES FOR OUTREACH, LEARNING, AND LONGEVITY (ENROLL) ACT”, introduced by Rep. Kathy Castor (D-FL), would provide $100 million annually for the Federally-facilitated Marketplace (FFM) navigator program. The bill would reinstate the requirement that there be at least two navigator entities in each state and would require the Department of Health and Human Services (HHS) to ensure that navigator grants are awarded to entities with demonstrated capacity to carry out the duties specified in the Affordable Care Act. The bill would also prohibit HHS from considering whether a navigator entity has demonstrated how it will provide information to individuals relating to association health plans or short-term, limited-duration insurance plans.

H.R.1385, the “STATE ALLOWANCE FOR A VARIETY OF EXCHANGES (SAVE) ACT”, introduced by Rep. Andy Kim (D-NJ) and Rep. Brian Fitzpatrick (R-PA), would provide states with $200 million in federal funds to establish state-based Marketplaces. Under current law, federal funds are no longer available for states to set up state-based Marketplaces.

Key Documents: Memorandum from Chairman Pallone to the Subcommittee on Health


  • Peter Lee, Executive Director, Covered California
  • Audrey Morse Gasteier, Chief of Policy, Massachusetts Health Connector
  • J.P. Wieske, Vice President, State Affairs, Council for Affordable Health Coverage

All three of these are also part of H.R. 5155's wish list:

  • Restore HealthCare.Gov's slashed navigator/outreach budget to pre-Trump levels
  • Reinstate the ACA's national reinsurance program (it lasted 3 years originally, sunsetting at the end of 2016)
  • Restore federal funding to help states move off of HC.gov onto their own state-based exchanges

In terms of how much the $10 billion reinsurance program would lower unsubsidized premiums on the ACA individual market, that would vary by state and carrier, but my rough back-of-the-envelope math suggests that it would be around 10%:

That's likely dropped off by over a million people over the past year or so (due mainly to the excessive premiums for unsubsidized enrollees, but assuming a robust reinsurance program were to boost enrollment back up to that level, that amounts to roughly $100 billion in total ACA-compliant premiums, give or take. $10 billion in reinsurance funding would lop 10% off the top of that.

One thing I'm a little fuzzy about is how this bill would handle states which have already implemented a reinsurance program via 1332 ACA waivers, like Wisconsin, Minnesota and Alaska. I presume the funding would only be available to states which haven't already done so...or perhaps in those cases they'd be able to replace their existing share of reinsurance funding with the federal funds.