Payers will soon have to decide on 2018 rates for the Affordable Care Act (ACA) exchange markets. Some insurers have already said they are pulling out of the exchanges next year while others have spoken out about not knowing whether Congress will make major changes to the healthcare system, particularly about whether Republicans will continue cost-sharing reductions (CSR) subsidies to insurers.
- White House officials say that more payers dropping out of the ACA exchanges could help boost the Republican bill to replace the ACA, which is now in the Senate, The Wall Street Journal reports.
CareFirst BlueCross BlueShield CEO Chet Burrell said the company has suffered $500 million in losses in the exchanges so far and expects to lose another $100 million on those plans this year. Burrell made the statement after announcing that CareFirst wants a 58% increase for individual insurance plans in Maryland, Virginia and D.C. in 2018, reported Baltimore Business Journal.
Payers will decide on rates and whether to continue in the ACA exchanges in the coming weeks with deadlines set for June. Already, Aetna and Humana say they are pulling out of exchanges next year. Meanwhile, Anthem, which made $1 billion in the first quarter, said it plans to stay in the exchanges in 2018. The Indianapolis-based payer has more than 1.1 million members in ACA exchanges.
A recent Oliver Wyman survey found that the “vast majority” of surveyed payers said they are committed to ACA exchanges next year. The report also warned that payers could change their minds when they get more information about 2017 ACA plan performance and potential regulatory and legislative changes, including changes to CSR subsidies.
Concern about major changes to healthcare and the Republicans not firmly backing future CSR payments is causing uncertainty among payers. They worry about setting rates or even staying in ACA exchanges without knowing whether the GOP will back the same level of subsidies that helps insurers in exchanges pay to cover lower income Americans.
Republicans believe that payers dropping out will create pressure on Democrats to work with them on a healthcare reform bill. Democrats, however, say that since Republicans control the White House and both houses of Congress, they now own the healthcare issue. Democrats would rather fix the ACA than repeal it and create a new law.
The next action on the American Health Care Act would be in the Senate, after the House narrowly approved the bill last week with a vote of 217-213. Senators over the weekend said the Senate will likely start from scratch on a new healthcare reform plan.
During his daily press briefing on Monday, Press Secretary Sean Spicer said President Donald Trump supports that all Americans “have access to healthcare that covers preexisting conditions, that is affordable.” Spicer said the approved House bill does that. But the bill would actually allow payers to charge people with pre-existing conditions higher rates in states that receive a waiver. It is not clear which states might apply for such a waiver, or what the process would be for getting one.
Spicer also said Trump is concerned about payers leaving the marketplace because it limits consumer choice.
“And he is very concerned that we are facing a choice right now where Obamacare is failing and dying, and that if we don’t act, that people won’t have access to healthcare and they won’t be able to afford it,” Spicer said.
With midterm elections next year, one key question is whether voters blame the Republicans for healthcare reform failures and problems with the healthcare system — or the Democrats for approving the ACA in 2010 and not supporting the Republican reform plan this year?
Whether the Republican plan approved in the House makes it into the Senate bill may largely depend on the Congressional Budget Office’s new estimate. The original GOP plan would have left 24 million people without health insurance by 2026. The CBO has not graded the approved GOP House plan yet.