The Obama Administration may extend beyond 2016 a federal reimbursement program for health insurance companies that lose money by participating in the newly created health care exchanges.
Industry insiders told the Washington Examiner a plan to extend the Affordable Care Act’s “risk corridors” are under discussion, but that administration officials have not made a final decision.
The risk corridor program was written into the 2,700-page health care bill to help the insurance companies offset losses if they enroll too few healthy customers and sign up too many people with high health care costs.
Risk corridors are aimed at keeping premiums from skyrocketing by requiring the government to “share in the risk associated with the new marketplace,” according to the health care lobbying group America’s Health Insurance Plans (AHIP).
Insurance companies pay into a pool to cover losses for companies that fare poorly but the federal government must step in if there is widespread loss, which some say could happen due to the lack of participation on the health care exchanges from young and healthy individuals.
The program, however is only meant to be short term, AHIP said, to “ease the transition between the old and new marketplace.”
But the disastrous rollout of the law resulted in millions of people on the individual market losing health care policies that did not include the “essential benefits” required under the new health care law, including maternity care and pediatric dentistry. The resulting public outcry prompted President Obama on Nov. 14 to announce that health insurance companies could allow customers to keep their old plans for an extra year.
The Obama Administration is now weighing a plan to grant an additional three-year extension for non-complaint plans on the individual market. Such a move would prevent millions of people from losing their policies in the critical weeks and months before the 2014 election.
But it would also allow people on the individual market to keep non-compliant plans beyond the risk corridor’s 2016 expiration date, leaving health insurance companies serving the exchange vulnerable to financial losses as the more healthy customers continue to stay out of the exchanges.
Health insurance companies are looking for something in exchange for the three-year extension, which will make it much harder for them to sign up healthier and younger customers. Extending the risk corridor program is part of that conversation with the White House, industry sources said.
“If the extension increases adverse selection, premiums will go up and taxpayers will be on the hook for more money through extending the risk corridors,” Mike Tanner, a health care policy scholar at the Cato Institute, a libertarian think tank, said. “The question is, how much? And I don’t think anybody knows because I don’t think anybody knows how many people we are talking about.”
John C. Goodman, the president and CEO of The National Center for Policy Analysis, believes insurance companies participating on the exchanges are headed for significant losses as the sickest and most medically vulnerable get dumped into the exchanges and waivers and delays are granted to the healthy.
In Detroit, for example, city officials are considering pushing onto the health care exchanges municipal retirees who are too young to qualify for Medicare.
“I can understand why they are talking about extending the risk corridors because I think the losses are going to be quite large,” Goodman said.
Health care law supporters point out that the federal government can make money off risk corridor programs. A Congressional Budget Office report last week predicted the federal government won’t lose a dime through the risk corridor program but will end up netting $8 billion.
The CBO based its estimate on the performance of risk corridors established under the Medicare Part D prescription drug benefit program passed by a Republican-led Congress and signed into law by President Bush in 2003.
“The risk corridor program was a good idea during the Bush administration, and it worked,” Rep. Elijah Cummings, D-Md., said during a recent hearing on the program. “Rather than a bailout for insurance companies, the program has resulted in $7 billion in net gains to taxpayers. But now since these same mechanisms are part of the Affordable Care Act, Republicans argue that they are a bailout for insurance companies.”
Critics in and out of Congress want legislation to repeal the risk corridors and warn that Obamacare won’t yield the same kind of results as Medicare Part D because of the much larger size and scope of the new health care law and the potential for a much larger pool of sick and unhealthy on the exchanges.
“Medicare Part D made money, but I don’t think that’s going to be true here,” said Douglas Holtz-Eakin, the former director of the Congressional Budget Office who now runs American Action Forum, which describes itself as a center-right policy institute.
Sen. Marco Rubio, R-Fla. has introduced legislation to repeal the risk corridor provision in the health care law, but Senate Majority Leader Harry Reid, D-Nev., has no plans to take up the bill.