The way things are going lately, you might think the only thing on Democrats' minds is Medicare for All. In fact, though, there exists a group of moderate Democrats with a different (and perhaps more realistic) focus: bring stability to the ACA markets by restoring subsidies for insurers that were terminated by the Trump administration.

The Hill reports that the New Democrat Coalition, consisting of 101 centrist Democrats, are trying to take what they see as the path of least resistance and push back against subsidy elimination while working with Republicans to bring down premiums for coverage under the Affordable Care Act.

“This is something that can be done this session, knowing that we can pass bills in the Democratic House, but we have to contend with a Republican Senate and with a Republican president,” said Rep. Annie Kuster of New Hampshire

Indeed, the Trump administration still looms large in the health care picture and Alex Azar, secretary of Health and Human Services, is pushing the idea of taking those ACA subsidies and using them to fund health savings accounts for people in the individual market so that they can use the money for premiums and other out-of-pocket costs.

The idea is one of several floated by Azar, along with a way to let high-deductible plans with HSAs cover preventive services such as providing free insulin. “This is just one possible way to help use insurance design to drive value by empowering patients as consumers of health care,” Azar said. “Plans with HSAs–especially funded HSAs–can protect Americans from the risk of catastrophic healthcare costs while encouraging them to be price-conscious consumers.”

According to Modern Healthcare, the notion of funding HSAs with ACA subsidies “follows recent guidance on 1332 state innovation waivers that gives states much greater leeway in how they use the federal advance premium tax credits that subsidize ACA exchange plans for people on the low-end of the income scale.”

While HSAs are on the rise as a means for employers to cut costs, and a prediction by the consultant Mercer expects 72 percent of large employers this year to offer a health plan with an HSA, that doesn't mean that Democrats will go along with the idea, particularly in the wake of the “Medicare for All” introduction by progressives.

Look for the health care battle to become a three-sided fight, as Republicans respond to 2018 election results driven by health care issues, centrist Democrats try to avoid radical action, and progressive Democrats see an opportunity, with the new majority in the House, to propose more far-reaching action.

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Azar, centrist Dems voice different goals for ACA subsidies

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