After the Graham-Cassidy Bill proposed by Republicans -- their latest Repeal and Replace effort -- failed to garner enough votes recently, patients, healthcare providers, and insurers still face plenty of uncertainty before open enrollment begins November 1. Meanwhile, Senator Bernie Sanders's single-payer proposal continues to gain fans. We'll get the latest on how national politics is shaping the health care debate across the country.
- Julie Rovner - Chief Washington Correspondent for Kaiser Health News. She has written extensively about the politics surrounding health insurance for KHN's Repeal & Replace Watch. Rovner also hosts the What the Health? podcast.
Governors and insurance commissioners are emerging as a force to reckon with in the healthcare debate.
The states know what they need to make their insurance markets work. For all their rhetoric about how the Affordable Care Act was a federal takeover of health insurance, states still do most of the regulating. And we actually saw on Capitol Hill last month -- when the nascent bipartisan effort was trying to get off the ground -- insurance commissioners and governors, Republicans and Democrats, pretty much surprisingly agreed on what they, the states, needed to make this individual insurance market stable. I was surprised at the unanimity among the Republicans and the Democrats about what it would take to stabilize the market and what Congress could do to help facilitate that.
How have the Trump administration’s actions affected the insurance market?
There’s a big fight in court with a lawsuit that pre-dated Trump but it has to do with billions of dollars in subsidies for low-income people -- not subsidies for premiums but helping low- and moderate-income people pay their out-of-pocket costs, their deductibles, and their co-payments, and their co-insurance, which under the Affordable Care Act can be thousands of dollars. And the insurance companies are not required under their contract to provide this help. The federal government is required under the law to pay them back. There's a technical glitch about whether that money was officially appropriated and basically the administration every month is saying it might or might not make these payments. That's had a huge impact on the market. A number of companies have dropped out. Others have raised their premiums.
We also have the administration kind of waffling about whether it's going to enforce the individual mandate -- the requirement that most people either have insurance or pay a fine. And of course if that's not going to be enforced, healthier people are less likely to sign up for insurance, which again prompts insurance companies to either drop out of the market or raise rates. So there's all this uncertainty. And basically the Republican and Democratic governors, and the Republican and Democratic insurance commissioners said, We need certainty. That's the one thing the insurance industry needs to go forward. This is not about helping the insurance industry per se; it's about having insurance available for people who need it.
Are insurance companies using “uncertainty” as an excuse to raise prices?
There is some of that. In a lot of states the insurance commissioners had insurance companies file two sets of rates -- one, if they were going to have these cost-sharing subsidies paid back, and one if they weren't. And it was about a 20 percent difference, but of course we still don't know. Congress didn't resolve it. They didn’t come to a deal to appropriate this money. So I think in most cases they had to lock in, and I think most of them locked in at the higher level. So in many places rates are basically 20 percent higher than they would have been if Congress had been able to come to this deal to just assure that this money that the federal government owes the insurance companies was paid.
"The GOP Repeal Bill Is Imploding. Here Are 5 Things Left Hanging On Obamacare," by Rovner for Kaiser Health News.
"Insurance Commissioners Say Help Offered By Congress Is Not Enough To Save Market," by Rovner for Kaiser Health News.
"Politics, Not Policy, Fueling Last-Ditch GOP Health Care Efforts," from NBC News.