Partisans on Insurance Stabilization Bills
Written by Editor   
Sunday, February 05, 2017 11:27 PM

News Bite:  One thing is clear.  When it comes to the Affordable Care Act there is too much "party-ing"  going on.

Trust. It's the missing ingredient in congressional efforts to stabilize the individual insurance market as Republicans move to repeal and replace the Affordable Care Act.

That was clear during a House committee hearing on four GOP bills to address various problems insurers say are forcing them to consider leaving the individual market in 2018. A mass exit would jeopardize coverage for the nearly 20 million Americans who have individual policies.

The four bills discussed reflect the GOP strategy of replacing Obamacare through a number of separate measures rather than one large bill. Republicans hope some of these individual pieces could draw support from Democrats, who want to make the ACA markets work.

The bills would give insurers greater leeway to charge older customers higher premiums; make it harder for people to sign up for coverage outside of the annual open enrollment period due to changes in life circumstances; shorten the period during which people would have coverage if they miss premium payments; and establish an alternative to the ACA's individual mandate to encourage people to buy and keep insurance.

HHS has proposed a rule to stabilize the insurance markets.  But Democrats say before they consider these measures, they want to make sure Republicans, who, for seven years, have demanded the law’s repeal, truly want to fix its problems rather than demolishing its patient protections and expansion of coverage to up to 30 million Americans.  “They need to prove their sincerity,” said Democratic Rep. G.K. Butterfield of North Carolina.

Faced with the complexity of repealing and replacing the law, some Republicans are talking about “repairing” the law rather than eliminating it, and keeping its taxes to fund replacement coverage. But hard-line House conservatives are insisting on rapid repeal, with some type of alternative model to come later. 

In the meantime, however, insurers and hospital systems are pleading for fast action to shore up the individual insurance markets. Aetna, Anthem, and other insurers warn that if policymakers don't give them the new rules of the road very soon -- before they have to file their 2018 plan offerings and rates this spring – they may exit the market.

But there was no discussion of insurers' main recommendations for stabilizing the individual market. Marilyn Tavenner, CEO of America's Health Insurance Plans, told the Senate HELP Committee that Congress needs to fund payments to insurers for the ACA's required cost-sharing reductions for low-income enrollees; preserve the law's premium subsidies to make coverage affordable; and restore risk payments to health plans that sign up sicker members. Those provisions face strong opposition from conservatives, who have blasted them as corporate “bailouts.”

It's critical to keep the law's requirement that nearly everyone buy insurance, which many experts say is needed to get younger, healthier customers into the market to balance the costs of older, sicker people. But the individual mandate is one of the GOP's top targets for quick repeal.

One GOP bill would let insurers charge older members five times more than younger people, rather than the ACA’s current limit of three times more.  Insurers argue this would enable them to attract more younger, healthier members to offset the high costs of older, sicker enrollees, and more accurately reflect the higher costs associated with older members.

But some experts predict it would make coverage unaffordable for older people and force some to drop coverage, while doing little to make premiums more affordable for younger people.