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Bipartisan ACA fix gains steam, but Trump persists on GOP go-it-alone

Taking a cue from Sen. John McCain, R-Ariz., who demanded last week that Congress find a bipartisan solution to fixing the U.S. healthcare system, 43 Republican and Democratic House members unveiled a five-point plan aimed at tweaking and shoring up, rather than dismantling, the Affordable Care Act, or ACA.

The group had been quietly meeting behind closed doors to work up a strategy to stabilize the healthcare insurance market, revealing their plan just days after the Senate Republicans failed in their attempt to repeal and replace the ACA.

The so-called Problem Solvers Caucus, co-chaired by Republican Rep. Tom Reed of New York and Democratic Rep. Josh Gottheimer of New Jersey, said its intent is to restore some predictability to the marketplace as insurance companies decide on premiums for 2018.

First up, the lawmakers want to take the ACA's cost-sharing reduction payments out of the Trump administration's hands and bring the funds under Congress' control, making them mandatory.

The payments help cover deductibles and copayments for about 7 million low-income Americans enrolled in ACA plans offered by private insurers through the government-run marketplace.

President Donald Trump, however, has repeatedly threatened to stop the payments — most recently this past weekend.

Insurers and some Congress members have criticized Trump's month-by-month approach on the payments, warning the uncertainty added to marketplace instability.

White House officials said Trump will take a decision early this week on whether his administration would continue making the payments.

Trump has not given up on the Republicans' go-it-alone strategy in attempting to repeal the ACA, insisting in a July 29 tweet they must try it again, otherwise they would be quitters.

But Senate Majority Leader Mitch McConnell, R-Ky., has said it was time to move on after his third attempt in one week to repeal the ACA failed July 28.

Other solutions

Among the other solutions the Problem Solvers Caucus wants to pursue is the creation of a dedicated stability fund that states could use to reduce premiums and limit losses for providing coverage, especially for Americans with pre-existing conditions.

They also want to change the ACA's mandate that requires employers to offer affordable insurance for their workers, raising the threshold from 50 employees to 500 or more.

The lawmakers said the current law's definition is a disincentive for small businesses to grow past 50 employees.

The caucus is also seeking to change the ACA's employer mandate definition of a "full-time" employee, raising the hours per week from 30 to 40.

In addition, they want to make technical changes and ensure that clear guidelines are provided for states that want to innovate on the ACA's exchange or enter into regional compacts to improve coverage and create more options for consumers.

One portion of the ACA that the bipartisan group agreed must be repealed is the 2.3% excise tax on medical devices — something both Democrats and Republicans have called for, although doing so leaves other areas of the law unfunded.

To offset the costs of their proposals, the caucus suggested recapturing overpayments of the so-called premium tax credits, which help Americans cover the cost of insurance purchased through the ACA's marketplace.

The lawmakers also suggested encouraging the use of generic medicines in the Medicare Part D prescription drug program and speeding up branded product discounts as seniors approach the coverage gap known as the "donut hole."

They also recommended creating a bundled payment system for post-acute care in Medicare and reducing payments under the program for bad debt.

In addition, the caucus said the competitive bidding process should be accelerated for the Medicare Advantage program.

"The last great hope for this country is that Republicans and Democrats prove they can work together," Reed said.

Gottheimer added: "For too long, healthcare has been viewed as a fiercely partisan battleground, but the Problem Solvers Caucus has shown that it is possible to forge cooperation and fight through the gridlock."

The caucus did not identify all the 43 members, but among those who have disclosed they are participating are Republican Reps. Martha McSally of Arizona, Carlos Curbelo of Florida, Adam Kinzinger of Illinois, Fred Upton of Michigan, Leonard Lance of New Jersey, John Faso of New York, and Charles Dent, Glenn Thompson, Ryan Costello and Lloyd Smucker of Pennsylvania; Democratic Reps. Kurt Schrader of Oregon, Scott Peters and Jim Costa of California, Tom Suozzi of New York, Jim Himes of Connecticut and Brad Schneider and Dan Lipinsk of Illinois.

Other efforts

While the Problem Solvers Caucus so far is a House effort, various members of the Senate have also been working on bipartisan proposals, including a guild of 10 Democratic and Republican senators who are former state governors, like Joe Manchin, D-W.V., and Lamar Alexander, R-Tenn.

Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee, also said he is pursuing efforts with ranking member Sen. Patty Murray, D-Wash., to stabilize the individual market. He said July 18 that he plans to hold additional hearings on the matter — follow-up sessions to a public forum he held in February.