Working through half a dozen proposals for what healthcare will look like under President Donald Trump, legislators earlier this week shared some of their wish list and a timeframe for implementation at the National Association of Health Underwriters’ annual legislative conference in Washington.

“We haven’t come to an agreement on the issues,” Rep. Chris Collins (R-N.Y.) told more than 1,000 health insurance agents gathered for the event. However, the member of the Energy & Commerce subcommittee on health said a consensus is starting to emerge on what the GOP wants to implement.

Republicans’ general goal in healthcare reform is “pretty simple,” added Sen. Lamar Alexander (R-Tenn.) “A fundamental problem with the [Affordable Care Act] was expanding a system that already cost too much and made it more expensive,” Alexander, chairman of the Senate’s Committee on Health, Education, Labor & Pensions, said. “We should try to give the American people more choices of lower cost insurance and move decisions out of Washington and into the hands of the states.”

[Image credit: Bloomberg]
[Image credit: Bloomberg]

The GOP wants to put the individual back in charge of their own health insurance, Collins added. They’d also like to see more companies and associations, such as chambers of commerce, pool together for coverage.

But, he said, “We are not going to do anything stupid. We are not going to leave people out to dry.”

Collins emphasized that one size does not fit all in healthcare. “It is not easy,” he said. “We are not going to do something … not well thought out or [that] has unintended consequences.”

The most urgent issue
While Speaker of the House Paul Ryan (R-Wis.) said in January he expects to repeal parts of the ACA by early March, lawmakers at the NAHU Capitol Conference repeatedly said it will be a longer process, done in stages. “Americans deserve to have it repealed, but it needs to be done the right way,” Alexander said.

Alexander believes Congress will do a piecemeal repeal, and only once “concrete alternatives” are in place. “That means, as Ryan has said, we will do most of our legislation on it this year,” Alexander said. “Most before summer,” but the full change and implementation of it will take up to six years, he added.

Alexander wants to start with the most urgent issue, which is the individual market, he said.

“We have to send a rescue team in on the individual market,” he said. “[HHS Secretary Tom] Price will start with some administrative fixes to stabilize it and once we stabilize it — say, for three years — we can move along and make long-term changes to the individual market and have discussions with state governments about Medicaid.”

Many of the ideas Alexander presented to stabilize the individual market were released Wednesday, after his speech, as proposed regulations by the Centers for Medicare and Medicaid Services. Those reforms include tightening enrollment periods for health insurance and giving insurers greater flexibility in designing plans sold through government exchanges.

The proposed rules would shorten the regular sign-up period for individual health plans sold under the ACA to a month and a half. They would also curtail special enrollment periods that allow people to sign up for coverage outside the regular window, which insurers have said let people game the system and sign up only after they get sick.

Another provision in the proposed regulations is targeted at people who enroll in coverage and then stop paying. In those cases, health insurers could apply new customer payments to past debts on unpaid premiums. The administration said such a rule was “important as a means of encouraging individuals to maintain continuous coverage throughout the year and prevent gaming.”

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Upcoming changes
Rep. Kyrsten Sinema (D-Ariz.) explained during the NAHU conference that, in her view, “a full repeal without a reasonable replacement would be devastating for families, the economy and the county.”

Collins acknowledged that to be true. “The Obamacare exchanges are still going to be there,” he said. “This year’s [open enrollment] is locked in stone. We are looking at the earliest [to a] 2019 timeframe.”

However, Collins said minor changes will be made before that, as Price has a lot of latitude to introduce directives for changes.

Collins expects Price to redefine benefit packages by removing essential health benefit requirements, “so you can start selling and promoting products to businesses that are very different.”

Those products, Collins said, would include high-deductible health plans with health savings accounts and some level of a refundable tax credit. “We are not going to call them subsides,” he said.

Regardless, Collins promised significant changes. “We are going to turn this country upside down over the next few years,” he said. “Call it repeal. Call it replace. Call it a fix. We have to get it right with healthcare.”

Additional reporting by Bloomberg News