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Democratic U.S. Sen. Elizabeth Warren does not agree with President Donald Trump on much, if anything. Republican Gov. Charlie Baker is no fan of the president's either.
So there they were Thursday, an unlikely duo, joining forces during a Senate hearing on Capitol Hill to tag team the White House in an effort to undermine Trump's threats to sabotage Obamacare by pulling back on federal funding that insurance companies use to lower out-of-pocket expenses for consumers.
Baker, a popular Republican governor with a background in health care, joined four other governors, including Democrats and Republicans, to testify Thursday before the U.S. Senate Committee on Health, Education, Labor and Pensions on ways to stabilize the individual insurance market in the wake of the failure of Affordable Care Act repeal efforts.
They appeared before the panel for more than three hours, with Baker playing a prominent role. "If Charlie Baker doesn't know what it's going to do, chances are none of the senators will," Montana Gov. Steve Bullock replied to one question about the impact of expanding the availability of low-premium, high-deductible plans.
The governors broadly agreed that cost sharing reductions payments, made by the federal government to insurers to keep co-pays and deductibles low, should be guaranteed in the short-term to provide market certainty and head off price spikes.
They also pushed for more flexibility for states through a simplified waiver process, a reinsurance program to protect against high-cost claims and the preservation of a mandate or incentives to keep younger, healthier Americans in the insurance pool.
Baker warned that the loss of the cost sharing reduction payments -- which are the subject of legal challenge -- could drive up premiums in Massachusetts by 20 percent, and he indicated that his administration would be filing for a waiver this week to set up a premium stabilization fund to buttress against the potential loss of CSR payments.
Warren, a stalwart liberal who came out Thursday in support of Vermont Sen. Bernie Sanders' "Medicaid for All" bill, played off Baker to challenge Trump's posturing on CSR payments, which he could cut to further undermine the Affordable Care Act.
When it came time for Warren to ask questions of the governors, the Cambridge Democrat directed all of her queries at Baker, for whom she had earlier given a generous introduction as a bipartisan cooperator with "considerable expertise" in the health care arena.
Warren started by asking Baker whether cutting CSR payments, worth an estimated $146 million to Massachusetts in 2018, would save the federal government money. Baker said it wouldn't.
She asked what he thought about proposals to allow consumers to buy "garbage plans," or cheaper health plans with high deductibles and fewer benefits. The governor said he didn't think it was necessary.
And, in a set-up for her big swing, she asked whether he had heard anything from his fellow governors to change his thinking about the need to preserve CSR payments. He hadn't.
"If the president's threat to cut cost sharing makes no sense financially either for the federal government, or for the states, or for the families, can you think of any policy justification for threatening to blow up the health insurance marketplaces in Massachusetts and around the country by deliberately driving up costs in this way?" Warren asked Baker.
Baker responded, "I think it would be a bad idea."
Baker's staff and political advisors spent weeks preparing for Thursday Capitol Hill appearance, and were pleased with his performance, including the rare interplay with the state's leading Democratic politician.
One senior aide said the governor's team was "not surprised" by Warren's line of questioning on the cost sharing reductions payments, for which Baker has already publicly advocated.
Tennessee Sen. Lamar Alexander, the HELP Committee chairman who is leading the bipartisan effort to stabilize health insurance markets under the Affordable Care Act, jumped in to offer some context for Warren's critique on the White House.
A court, Alexander noted, ruled against the CSR payments that were included in the ACA, but not funded by Congress. Though the case is still under appeal, Alexander said the Trump administration has been directed by the judicial branch not to make the CSR payments without a Congressional appropriation.
"What we would like to do, I would like to do, is clear that up by appropriating the money for a period of time," Alexander said, before offering Warren a chance to respond.
"I need no rebuttal," Warren said. "If this Congress moves forward and authorizes the money and gives our states the ability to stabilize their markets under the Affordable Care act, I'm all in."
Baker testified that Congress should appropriate money to cover CSR payments for at least the next two years to give insurers who are working to set rates for 2018 and 2019 some certainty as to the funding that will be available while longer term cost controls are debated.
Alexander, who is working closely with Sen. Patty Murray, a Washington Democrat, said he hopes to present a bipartisan plan to stabilize the individual health insurance market to Senate Majority Leader Mitch McConnell and Minority Leader Charles Schumer within the next 10 days.
He also said supports a CSR guarantee for at least 2018, but will consider the governors' request for a multi-year appropriation.
The HELP Committee's work is narrowly focused on the individual market, which accounts for 6 percent of the insured in the country.
"We're trying to take a small step here that will lead to bigger steps," Alexander said, suggesting reform of Medicaid and broader health care cost control measures could be dealt with after markets are stabilized.
Gov. Gary Herbert, a Utah Republican, described himself as "not a fan of cost sharing reduction payments," but said they were a short-term necessity to prevent premium spikes and the loss of insurance options for consumers in some parts of the country.
Sen. Lisa Murkowski, the Alaska Republican who was one of three Republicans to vote against the GOP Senate repeal bill, lauded the public process Alexander and Murray were pursuing after the backroom dealmaking that was a hallmark of the failed Obamacare repeal-and-replace negotiations.
"This cannot be the Republican solution to health care, just as having a Democratic solution to health care was not the answer for us either," Murkowski said. "The process is better when it's open like this."
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