A Needed Prescription

For Tucsonan Sean Murphy, adequate insurance was a matter of life and death.

In 2004, Murphy was diagnosed with cancer. Luckily, with insurance provided through work, Murphy was able to receive the care he needed and recover from his life-threatening diagnosis.

But his bout with cancer left him labeled with a pre-existing condition, making it nearly impossible for him to purchase an individual insurance plan.

As a result, he was faced with two options: remain in a job he wished to leave, or live without insurance because premiums would have cost more than his mortgage. Murphy stayed with the job for eight years but was finally able to move on to a new gig in 2015 once the Affordable Care Act’s individual marketplace opened up.

“As soon as the Affordable Care Act was implemented, I was free to move on,” Murphy said. “[Insurance companies] couldn’t discriminate against me for a pre-existing condition any longer, and cancer is something providers don’t ignore.”

Murphy is one of millions of Americans that benefit from the individual insurance marketplace, a subsidized feature of the Affordable Care Act that is designed to sell plans to people who aren’t provided insurance through public programs such as Medicaid (aka AHCCCS in Arizona) or their employer.

Following the meltdown of the Senate’s Better Care Reconciliation Act and the “skinny repeal” last month, President Donald Trump has threatened to crash the individual marketplace by cutting off that federal funding, while Senate Majority Leader Mitch McConnell has suggested that taking steps to shore up the individual marketplace amounts to a “bailout” for insurance companies.

With such uncertainty, insurance companies are struggling to determine what kind of rates they should charge on the individual marketplace—or if they should offer plans at all.

But some members of Congress on both sides of the political aisle are stepping up to provide the funding. Senate Health Committee Chairman Lamar Alexander (R-Tennessee) and senior Democrat Sen. Patty Murray (D-Washington) announced that on Sept. 4, the Senate Health, Education, Labor and Pensions committees plan to hold hearings to discuss the future of stabilizing Obamacare’s markets by 2018.

Another bipartisan effort, which complements the hearings in the Senate, comes from the Problem Solvers Caucus. This 43-member group of Republicans and Democrats represents a House-led effort to shore up the Affordable Care Act’s marketplaces.

With insurers set to renew their contracts with the Affordable Care Act by Sept. 27, this leaves legislators nearly two months to hash out a bipartisan arrangement for individual insurance markets before premiums rise.

As it stands, the individual marketplace benefits from government subsidies and cost-sharing reductions, which are designed to alleviate the pressures of copays and deductibles for citizens earning anywhere from 100 to 250 percent of the federal poverty level. Since the Trump administration entered office, these subsidies and cost reductions have been granted on a month-to-month basis.

On July 29, Trump took to Twitter stating: “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” With the lingering threat of ending government aid altogether, insurance companies are now considering a hike in their rates.

Among those seeking to craft a bipartisan, Republican-led plan to stabilize the Affordable Care Act marketplace are three members of the Arizona congressional delegations, Reps. Martha McSally (R-AZ02) and Democrats Tom O’Halleran (D-AZ01) and Kyrsten Sinema (D-AZ09).

“For the last several weeks, I have led a bipartisan working group with fellow members of the bipartisan Problem Solvers Caucus to find solutions we can agree upon to stabilize the individual market while also providing immediate relief to constituents, families and small businesses,” Rep. McSally said in a press release. “This is not about saving or killing the Affordable Care Act, or scoring political points. This is about identifying and negotiating real solutions to real urgent problems and helping the people who have been harmed most by the ACA.”

Though efforts to thaw partisan disagreements on health care are in the works, there remains staunch resistance from Senate Majority Leader Mitch McConnell (R-Kentucky), President Trump and others. In recent days, Republican senators Bill Cassidy of Louisiana, Dean Heller of Nevada and Lindsey Graham of South Carolina, in conjunction with the White House, have suggested that plans are in the works to propose a second bout of “repeal and replace” legislation.

The marketplaces, though they represent only a small percentage of people who are covered through the Affordable Care Act, face extreme rate hikes and rising uninsured levels if a bipartisan solution isn’t found within the next few months. Trump’s threats to cease cost-sharing reductions with the individual insurance marketplace pose a threat to middle-class Americans who earn too much to qualify for the Medicaid coverage, but can’t afford the premiums of unsubsidized insurance. And while negotiations are now in the works, the road remains fraught with challenges. For Sean Murphy, the uncertain future of health care is unsettling.

“The ACA isn’t perfect, but at least it tries to help people” Murphy says. “With the party of opposition working to dismantle it, well, that’s a scary feeling. My wife and I aren’t getting any younger, and we both have significant pre-existing conditions. We would be among the people who would really suffer as a result. We live healthy lifestyles, we pay our taxes, we work hard, we pay into the system and we’re upstanding citizens—now we’re being punished for that. It’s kind of hard not to be angry.” ■

This article appears in Aug 10-16, 2017.