Senators aim for ACA fixes, Murkowski-style

Sen. Murkowski greeted health care advocates after the hearing. (Liz Ruskin)

A U.S. Senate committee met Wednesday to figure out what to do about health care. The hearing was open and bipartisan, just the process Sen. Lisa Murkowski was calling for when she cast a key vote against the repeal-and-replace plan Republican leaders drafted behind closed doors. But time is short.

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The Senate has only a few days to stabilize the individual market across the country before insurance companies finalize their rates, and senators think Alaska has pioneered one tool that can help.

The session was in one of the Senate’s largest hearing rooms. Some in the audience wore lab coats and scrubs. Others came in wheelchairs. At least two people had paper face masks, the type vulnerable patients wear to avoid infection.

Alaska Insurance Division Director Lori Wing-Heier advised senators how to improve the Affordable Care Act. Photo by Liz Ruskin.

Committee Chairman Lamar Alexander, R-Tenn., urged senators to focus on relatively small fixes to the Affordable Care Act, to add stability to the individual market, where 6 percent of Americans buy their coverage. Alexander said senators need to be quick, because at the end of the month insurance companies submit their final rates for 2018.

“We ought to be able to take this small, limited, bipartisan step on health insurance,” Alexander said. “If we don’t, millions of Americans will be hurt.”

Alexander is singing Murkowski’s tune. Murkowski agrees Congress should fix flaws in the Affordable Care Act now, to bring down insurance costs. More broadly, she’s a huge fan of using the committee process to craft bills, about health care and everything else. It’s become a Senate rarity in recent years. Big bills are often negotiated among the leaders of the majority party and then opposed by nearly every member across the aisle.

“The interest in doing (a health care bill) in a bipartisan open process way – this is a world apart from where we were the end of July. And I think that’s significant,” Murkowski said.

Lori Wing-Heier (Photo by Liz Ruskin)

One of the witnesses at the hearing was Alaska Insurance Division Director Lori Wing-Heier. Earlier this year, she accomplished a massive administrative feat: She got a waiver of the Affordable Care Act rules to fund Alaska’s re-insurance program. The program pays for the treatment of several high-cost medical conditions. It brings down premiums for people who buy on the individual market, which allows the government to pay less in premium subsidies. Alaska doesn’t get more from the federal government than it would have; it’s using the money that would go to subsidize premiums to lower premiums for everyone, even those who make too much money to qualify for subsidies.

Premera, the only insurer in Alaska’s individual market, credits the reinsurance program for its decision to lower premiums 20 percent.

Again and again, senators asked Wing-Heier how other states can replicate Alaska’s success. She said she’s already submitted a list of suggested rule changes.

“The waiver process is somewhat onerous in the fact that there is not a defined application to submit,” Wing-Heier said.

Wing-Heier said states essentially have to guess what data are required. And then there’s a six-month waiting period for approval. The senators took note. Improving the waiver process is on chairman Alexander’s immediate to-do list.

When the hearing ended, health care advocates in the audience went forward to talk to Murkowski. They thanked her for being one of three Republicans to vote against repealing the Affordable Care Act in July.

An Arkansas college student named Kati McFarland lifted her shirt to her naval to show Murkowski the feeding tube she depends on.

“Without the ACA I would literally starve to death, so I just wanted to thank you again,” McFarland said.

The committee plans three more hearings this month, all focused on lowering premiums in the individual market.

Meanwhile, some Senate Republicans are still hoping to repeal the Affordable Care Act with a new bill, known as Graham-Cassidy. The deadline for passing that with a simple majority is also at the end of the month.

Liz Ruskin is the Washington, D.C., correspondent for Alaska Public Media. She reports from the U.S. Capitol and from Anchorage. Reach her at

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