House Republicans suggest change to age rating in ACA

Rather than focusing on efforts to repeal or defund portions of the Affordable Care Act, House Republicans discussed five pieces of legislation aiming to make smaller changes to the law at a congressional hearing June 10.

The changes would all deal with rules surrounding the health insurance exchanges and the premiums for marketplace plans.

The most drastic change would come from Indiana Republican Rep. Susan Brooks’ legislation to expand the allowable age-related variation in premiums. Currently, insurers are allowed to charge older people up to three times as much as young policyholders to make up for the cost of their care. Brooks’ bill would raise that limit to a 5:1 ratio, unless a state specifies otherwise.

Conservative groups like the American Action Forum and the Galen Institute testified in support of the change, arguing the ACA’s current age-rating restrictions has led to higher premiums and kept younger, healthier customers off the exchanges.

“These higher age ratios strike a careful balance: they provide protection to older consumers without making it impractical for younger consumers to purchase insurance,” wrote Galen Institute President Grace-Marie Turner. “Making health insurance too expensive for the healthier young people we want in the insurance pools drives them away, increasing the cost of insurance for everyone who remains.”

The third witness at the hearing, the Commonwealth Fund’s vice president of health coverage and access, Sara Collins, was opposed to charging older consumers more, saying the plan may lower some premiums for younger people, but would lead to older adults losing coverage and requiring more federal subsidies

“There is also no guarantee that these new enrollees will in fact be healthier than average,” Collins wrote in her testimony. “Since carriers are allowed to rate on age, but barred from rating on health, swapping out older adults for younger adults may in some cases leave them more exposed to risk.

The other proposals included:

·         Shortening the nonpayment grace period before coverage is cut off from 30 days to 90 days

·         Requiring eligibility verification for special enrollment periods

·         Allowing patients to shop for off-exchange, standalone dental plans

·         Creating an audit process for “failed state exchanges”

Republicans on House Energy and Commerce Committee’s Health Subcommittee largely argued these changes would reduce some unnecessary regulations put in place by the ACA.

“More government bureaucracy, regulations, and spending never successfully reduce the price of health care,” said Rep. Joe Pitts, R-Mo., the Health Subcommittee’s chairman. “Yet that is exactly the premise of how health insurance is regulated today – with top down mandates that empower Washington and remove control over health care decisions from states, small businesses, families and individuals. This has to be changed if we truly want bottom up solutions that provide better care at lower costs for patients.”

Rep. Gene Green, D-Texas, the ranking Democrat on the panel, accused Republicans of trying to help insurance companies over patients with the bills, but did express some optimism that some Republicans have moved away from talk of a full repeal.

“I'm happy about it,” Green said to The Hill. “I've been asking for that for about six years. Let's go back and fix it, because any bill Congress ever passed, typically we wait a year or two, see how it works, we go back in and fix the problems. We haven't had that opportunity because it's always just repeal.” 

Other House Republicans have shown similar interest in keeping at least parts of the ACA intact in recent months.

While there’s no guarantee the subcommittee will act on the legislation, Rep. Pitts told The Hill it has tentatively scheduled time in August for further discussion and possibly votes on these bills.