Bipartisan Health Care Stabilization Act of 2017

The Bipartisan Health Care Stabilization Act of 2017 (colloquially known as the Alexander-Murray bill) was a 2017 proposed compromise reached by senator and HELP Committee chairman Lamar Alexander and senator and HELP Committee ranking member Patty Murray to amend the Affordable Care Act to fund cost-sharing reductions subsidies.

[2] The CSR subsidies are paid to insurance companies to reduce copayments and deductibles for a smaller group of ACA enrollees, those earning less than 250% of the federal poverty line (FPL).

[4] Under the Obama administration, these cost sharing reduction payments were paid out because the Department of Health and Human Services argued that the premium tax credits and the cost sharing reductions were "economically and programmatically integrated" in the Affordable Care Act, and so the appropriation that covers the premium tax credits also allowed HHS to pay CSR payments.

[5] This was among the actions taken by President Trump to start to dismantle the Affordable Care Act after Congress had failed to repeal it earlier in 2017.

CBO expected the exchanges to remain fairly stable (e.g., no "death spiral") as premiums would increase and prices would stabilize at the higher (non-CSR) level.

Another 13 million who are now covered under the ACA's Medicaid expansion (in the 31 states that chose to expand coverage) should not be directly affected by the President's action.

The expanded state waiver flexibility would result in increased costs, but this would be brought down by the restoration of CSR payments as well as the addition of "copper" tier plans.

The legislative calendar at the time looked fairly full, and so it quickly became clear that passage of Alexander-Murray would have to come as part of some larger agreement.