Insurers have a message for Congress: Figure out the basics of Obamacare repeal and replace, and do it fast.
It’s all well and good that Republicans want to improve health insurance with a variety of reforms, insurance experts told the Senate Health, Education, Labor and Pensions Committee Wednesday morning. But first they have to solve two pivotal problems: Ensuring healthy people have health coverage even without a mandate to buy it, and helping insurers stem their Obamacare losses so they keep selling that coverage.
“First, we have some basic rescue work that has to go on,” said Marilyn Tavenner, president of America’s Health Insurance Plans.
A number of Republicans, including House Speaker Paul Ryan, have proposed plans to replace the Affordable Care Act. But lawmakers are struggling to agree on how to proceed, and while they want to pass new provisions such as allowing interstate sales of health insurance or expanding the use of health savings accounts, they’re facing much more urgent questions of how to keep the individual insurance market stable during a transition period.
“Before we do anything with HSAs, we have to figure out why people don’t stay continuously covered, we really have to figure out this whole enrollment process,” said Janet Trautwein, CEO of the National Association of Health Underwriters.
Tavenner laid out the insurance group’s most detailed request yet for how Republicans should go about repealing and replacing the Affordable Care Act. The national association of insurers appears resigned to the fact that the GOP will repeal the Affordable Care Act’s individual mandate, the law’s tool to force healthy people to buy coverage and offset costs from sicker people.
But if the individual mandate is going by the wayside, lawmakers must at least replace it with some alternative policies to ensure people don’t just wait to buy coverage until they get a disease or chronic condition, the association says.
Tavenner stressed the need for a continuous coverage requirement, allowing insurers to charge people with pre-existing conditions higher premiums if they have any gaps in coverage.
Insurers also are pressuring Congress to appropriate money for two kinds of federal assistance: Cost-sharing subsidies that Republicans had tried to block, but which help the lowest-income marketplace customers pay for out-of-pocket expenses, and the premium tax credits available to those earning up to 400 percent of the federal poverty level.
Without those subsidies, even more insurers would withdraw from the Obamacare marketplaces next year, Tavenner said.
“I think we would lose more insurance companies,” Tavenner said. “We have already lost significant numbers in 2017, I think we would lose more in 2018.”
Insurers are worried that Republicans might repeal the healthcare law without a replacement in place, although lawmakers are increasingly voicing concerns about that type of an approach. HELP Committee Chairman Lamar Alexander has been one of the most vocal lawmakers in calling for repeal and replace to happen at the same time, to give insurers the certainty they need about what is coming next.
“President Trump has said, very helpfully, that repeal and replace of Obamacare should be done simultaneously,” Alexander said. “To me, that means you need to know what you’re going to replace it with before you have an effective repeal.”
Republicans in their quest to repeal big parts of the healthcare law are unlikely to get any help from Democrats, who expressed deep frustrations and criticized their colleagues for talking about repeal without a replacement ready.
The Obamacare marketplaces were already struggling under big premiums increases and reduced competition. But Democrats charge that by upending the law, Republicans won’t fix the individual market but instead make things worse.
“They are now creating ‘Trumpcare’ by sabotage,” said Sen. Patty Murray of Washington, the top Democrat on the HELP Committee.
