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Health Insurers Face 'Massive Confusion' As GOP Wavers On Obamacare

While Republicans in Congress are talking about taking their time to change the Affordable Care Act, insurers are already struggling to figure out what to charge for coverage in 2018.
Pablo Martinez Monsivais
While Republicans in Congress are talking about taking their time to change the Affordable Care Act, insurers are already struggling to figure out what to charge for coverage in 2018.

Premiums for Obamacare plans sold by New Mexico Health Connections could rise as little as 7 percent next year, said Martin Hickey, the insurance company's CEO. Or they might soar as much as 40 percent, he said.

It all depends on what happens in Washington. Such is the vast uncertainty about how the Trump administration and Republican-controlled Congress are approaching their promises to repeal, repair and replace the Affordable Care Act, also known as Obamacare.

There is "pretty massive confusion," said Hickey, whose 45,000-member plan is one of the few nonprofit insurance co-ops created by the ACA to still be in business. "The more uncertainty they create, the higher the rates" will be for 2018, he said.

Insurers have a hard enough time making the normal predictions of who will get sick and how much care will cost. Now the usual fog of rate setting is compounded by the possibility that basic rules of coverage could get overhauled or even disappear before anything takes their place.

Consumers and patients could ultimately pay the price.

The stakes include how much plans sold through the health law's online marketplaces and similar coverage will cost in 2018 — or even whether insurance will be available. Challenges during the recently completed enrollment period, in which some carriers canceled plans and rates rose 20 percent on average, increase the urgency, executives say.

"This is nothing less than a nightmare scenario for the carriers," said Robert Laszewski, a former insurance executive and consultant who works with large plans. "The Republicans don't seem to understand that they've got to stabilize the market."

Coverage for 2017, which has already been finalized, won't change. People covered through job-based insurance or the private Medicare plans for seniors won't be much affected by the uncertainty.

In some states, preliminary 2018 rates are due in less than two months. But prospects for policymaking clarity recede each day that Republicans deliver contradictory messages or fail to agree on a plan, industry officials say.

While some in the party want to go slow on an overhaul and ensure they've thought out a replacement before abolishing the health law, others favor immediate repeal.

If the administration and Congress scrap the ACA's coverage requirement for most people or its subsidies helping people buy care, the market could deteriorate or collapse, say insurance consultants and executives.

A month ago President Trump told The New York Times that Obamacare is "a catastrophic event," adding, "we have to get to business" in repealing it. On Feb. 5, he seemed to advocate a more measured approach, telling Fox News that "at least the rudiments" of a replacement would be in place by 2018.

Even that could spook insurance executives contemplating plans for next year in the Obamacare marketplaces, also known as exchanges. They want to know the rudiments of a replacement plan now and details not much later.

"I don't think there's a real clear path to repeal or replace or repair or anything," said Kevin G. Fitzgerald, an insurance lawyer with Foley & Lardner. "Some of our clients will probably move forward on the assumption that something will happen to maintain the exchanges more or less the way they are. Others may pull out early."

Big, national insurers have said it would be hard to commit to the marketplaces next year unless they get a much better idea of what they'll look like.

Several had already scaled back coverage for this year, leaving many parts of the country with only one company selling through the marketplaces. Continued uncertainty could prompt even those holdouts to bail, said Fitzgerald.

"If in those states those carriers decide, 'We've lost enough and we're going to sit this year out,' there are no exchanges," he said. "And that certainly is a possibility."

The Trump administration has proposed regulations, initiated in the last days of the Obama regime, intended to steady the market. Tweaks may include crackdowns on sick consumers who join plans outside open-enrollment periods and allowing insurers to charge slightly more for older members, Huffington Post and Politico have reported.

Those changes — plus assumptions that Republicans will eventually have a replacement plan helping Obamacare patients maintain coverage — could reassure insurance companies, said Dan Mendelson, CEO of Avalere Health, a consulting firm.

"I'm not saying it would be completely pain-free," he said. "You probably would see some plans get out of the market. But if plans start to believe there's a long-term solution, they're going to want to stay in because getting in and out of the market costs money."

What industry really wants is certainty government will continue helping consumers pay for coverage — one of the most contentious and uncertain aspects.

For two years the Republican-controlled House of Representatives has legally challenged one type of subsidy — federal payments to reduce out-of-pocket costs for lower-middle income consumers. The Obama administration defended the subsidies in court, but insurers worry that Trump officials could drop the defense or that a judge could declare the payments illegal.

Industry interest in the suit "is incredibly high," said Todd Van Tol, a partner with Oliver Wyman, a consultancy with many insurers as clients. The disappearance of those subsidies, he said, "would likely trigger a fairly significant insurer pullback in fairly rapid order."

Even the most publicly minded insurers might cease offering individual Obamacare plans if an uncertain market threatened their financial stability, said Ceci Connolly, CEO of the Alliance of Community Health Plans, a trade group of nonprofit carriers.

"We want to be able to do this, but if there's potential for significant losses it would be irresponsible to maybe do it," she said. "There seems to be a growing recognition of the challenge ahead and also the need for stability, but boy — this clock is coming up fast."

Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. You can follow Jay Hancock on Twitter: @jayhancock1.

Copyright 2023 Kaiser Health News. To see more, visit Kaiser Health News.

Jay Hancock