Between a shifting landscape where insurers are morphing into more than payers and uncertainty of the midterm elections and the impact on health policy, there's a lot on Matt Eyles plate. Eyles leads America's Health Insurance Plans, the industry's largest trade group, and last week he sat down with Healthcare Dive to talk about the organization's legislative priorities and how AHIP is seeking to representing more than just insurers.
HEALTHCARE DIVE: What do you see as the three biggest issues facing the industry this year?
MATT EYLES: For the rest of the year, I think the legislative priorities are really focused on the health insurer tax that hits all different programs. [We are] Trying to get that suspended for 2020 because if we don't then either Medicare premiums or commercial premiums will go up or benefits have to be cut. It hits small businesses particularly to the tune of several hundred dollars of additional premiums, so that’s a big one.
The second one is really ensuring that the changes to the Part D coverage gap remain in place. Those were some changes that were made back in March under the budget agreement. We think it's really important that those stay in place so costs are lower for Medicare beneficiaries who rely on Part D and it doesn't result in higher cost for taxpayers too.
What will be the biggest changes to the industry if the Democrats take one chamber of Congress in the midterms?
EYLES: I think that one of the focus areas will really be the price of prescription drugs. There is a lot of attention and momentum, the administration is acutely focused on prescription drug pricing issues with their blueprint and have moved forward now with proposed regulations on requiring price disclosure in direct-to-consumer advertisements, we think that’s a really positive step. I think we're going to have to focus on affordability, too.
When you look at the overall cost of healthcare and within the context of the individual market there might be some actions that we could move forward with. But I think people will be really focused on affordability because we're at a point where something needs to happen.
Large insurers have left AHIP over the years, how does that change AHIP's strategy on the Hill? Do you see yourself needing to grow the tent or becoming more niche to the payers that are left?
EYLES: I think there is a really great opportunity for us to represent the new developments that we see across the industry with this move towards more vertical integration. We have a number of plans already that are both providers and plans at the same time. I think this is a trend of more integration, there is no reason that you should have separate medical from separate pharmacy from separate behavioral health. All of these are about getting our arms around the total cost of care, and ways that we can make it more efficient and a simpler and better experience for patients.
I think what we're doing is very consistent with the direction that they're heading and we certainly want to represent the entirety of the industry.
Will that include having to change your name from America's Health Insurance Plans?
EYLES: I think we'll have to think because if you're not just health insurance anymore, you need to think about those things.
How worried are you about the Texas lawsuit?
EYLES: We're very engaged in tracking what's happening with the suit. I think many people know we filed an amicus brief focusing on the significant disruption that would happen across the entire healthcare system if the law were overturned. If it is found unconstitutional, not only would it affect the individual market, which would be significant, but it would undo Medicaid expansion. It would result in changes to Medicare and the Part D coverage gap program that was put in place. It would touch the entire healthcare system and be incredibly disruptive. We're waiting to see what the initial decision is from the judge and we also recognize we're probably just at a starting point in the process.
There is another court house that's working it's way through in Maryland and we'll see what happens and whether or not they get joined. We're certainly very mindful about what it might mean for people who have pre-existing conditions and who need access to coverage. So we'll be following it very closely.
Many had talked about social determinants at AHIP's annual conference last week, but some had voiced concern about how to execute on that and with a return on investment. What should plans start with and is there a role for AHIP to play in answering those questions?
EYLES: Some of the answer depends on the population that you're serving.
I think a good place to look is some of the innovations we're seeing in Medicare Advantage. Even for the 2019 year, plans are out providing supplemental benefits that they really haven't before whether it be nutrition, adult day care. I think the takeaway is there is a great recognition by the industry that this is a priority, and how it applies to your specific business or product line may differ. There's a great role for AHIP to play both in terms of identifying best practices and acting as a convener to answer some of these important policy questions.
What do you think of the short term plan alternatives from the Trump administration?
EYLES: We're still waiting to see how that market evolves. The rules took effect Oct. 1 and we're still trying to figure out what does that market really look like and what impact will it have. The open enrollment period hasn't yet started for the 2019 year in the individual market.
We thought that there's a role for short-term plans in the market but they should be short term and of limited duration. It's a little too early to evaluate the actual impact.
Is there a role for private payers in a Medicare for all system?
EYLES: Not as it's currently being defined. That's really the challenge is that it’s really being positioned as what I would characterize as a regression to the old Medicare fee-for-service model and making that sort of the standard. That's a 1960s benefit package.
It really won't allow for the innovation that we've seen through Medicare Advantage, through the private market, and in Medicaid. If you came to this conference five years ago the types of care programs and innovations in terms of adding social determinants, you wouldn't have heard that. I don't know that you would hear that in a system that was so centralized and run essentially by the government.