Republican senators say fixing individual market should be first step in ACA repeal
By Virgil Dickson
February 1, 2017 - Modern Healthcare
Republican lawmakers say that as they consider ways to
repeal and replace the Affordable Care Act, they want to first take measures to
stabilize the individual marketplace before focusing on efforts to reform
Medicaid and roll back expansion.
During a Senate Health, Education,
Labor and Pensions Committee hearing Wednesday aimed at assessing the stability
of the individual insurance market, Chairman Alexander Lamar (R-Tenn.) suggested
the marketplace was in danger.
gUnless we act soon, insurance companies
won't be selling health insurance on the exchanges next year, and people won't
have access to health insurance,h Alexander said, adding that subsidies provided
through the ACA for people to buy individual plans would be akin to, ghaving a
bus ticket in a town with no bus.h
A panel of witnesses that included
representatives from America's Health Insurance Plans, the National Association
of Health Underwriters and the National Association of Insurance Commissioners
agreed with Alexander that this was the best course of action.
it's critical that Congress take some sort of concrete action by March as plans
mull further involvement in the individual market.
Insurance giants Aetna
and Anthem this week signaled that they were concerned about continued
participation in the ACA-created marketplaces.
gIf we can't see stability
going into 2018 with respect to either pricing, product or the overall rules of
engagement, then we will be making some very conscious decisions with respect to
extracting ourselves,h Anthem CEO Joseph Swedish said.
gStrong signals of
certainty can help stabilize the market, avoiding even higher costs and fewer
choices,h said Marilyn Tavenner, the AHIP president who served as CMS
administrator during implementation of the ACA.
Specifically, she asked
that lawmakers continue to provide subsidies such as the advanced premium tax
credits and cost-sharing reduction payments in their entirety for the next two
to three years and that they make full federal reinsurance payments for 2016,
which is a pool of funds paid to insurers for higher risk
Tavenner insisted that it's critical the individual mandate
continue to be enforced. President Donald Trump and Republican leadership have
signaled they would get rid of penalties against people who choose to go without
insurance coverage, but they have also been cagey about adamantly saying the
fines would go away since that might immediately destabilize the
gAs long as current market rules that prohibit the exclusion of
pre-existing conditions, require guaranteed issue of insurance policies and
impose community rating requirements on insurers remain in place, there is a
corresponding need for incentives for people to purchase and keep continuous
coverage,h Tavenner said.
Following the hearing, Alexander told reporters
that it's possible the HHS secretary will be able to implement many of the
short-term suggestions through rulemaking. The Senate Finance Committee
Wednesday advanced confirmation of Rep. Tom Price (R-Ga.) for the post to the full
Senate without Democrats casting a single vote.
As for Medicaid
expansion, Alexander added that the issue should be discussed among
Several lawmakers from both sides of the aisle asked former
Democratic Kentucky Gov. Steve Beshear, who was also a witness, about the impact
of capping funding for state Medicaid programs.
great. but when you give me 50% less money, then you're saying 'Governor, you're
the one who's going to have to cut people,' h Beshear said. gFolks are gonna