NASHVILLE — The nation's insurance industry faces another pivotal chapter as it confronts mounting consumer frustration over costs and scrutiny from lawmakers — not to mention calls for "Medicare for All" from many 2020 Democratic presidential hopefuls.
Amid these headwinds, executives from Cigna, UnitedHealthcare, Anthem and other Blues plans descended on Nashville to debate the hottest topics at an annual industry conference, from social determinants of health to telehealth to paying for value.
But underscoring much of the conversation was an acknowledgement of the high price of healthcare and consumers struggling to afford it.
"Affordability is once again at the pinnacle of the conversation," David Cordani, CEO of Cigna and chairman of AHIP, said in a speech opening the conference. Cordani likened the current landscape to previous disruptive "chapters" in the industry, including the early 1990s with the rise of HMOs and the the Affordable Care Act being approved in 2008.
As the conference unfolded, lawmakers in D.C. continued to mull over legislative fixes to eliminate surprise billing, or when a patient unexpectedly receives an out-of-network bill despite going to an in-network facility. Meanwhile, President Donald Trump is expected to sign an executive order Monday that aims to tackle price transparency. The order directs HHS to begin rulemaking that would make public information based on negotiated rates and require payers and providers to give patients estimates of out-of-pocket costs before a procedure.
The message from AHIP's leaders was: "We hear you, consumers."
"We really do have to tackle head on the issue of affordability," Matt Eyles, CEO of AHIP, told Healthcare Dive.
The frustration is piling up. Many of the nation's largest insurers are now hitched to the biggest pharmacy benefit managers with CVS' acquisition of Aetna and Cigna's buy of Express Scripts.
There is a growing feeling that insurance companies are unwilling or unable to perform that basic function, which is to negotiate provider prices and keep them in check, Sabrina Corlette, a research professor at Georgetown University, told Healthcare Dive.
"And if they can't do anything to contain provider prices, then what are they good for?," Corlette asked.
Brian Tanquilut, an analyst with Jefferies, said the exposure for insurers is their PBM business, given lawmakers' focus on reining in drug prices and eliminating rebates.
Fed up with increasing costs, some businesses have sidestepped insurers altogether and contracted directly with providers, including GM's deal with the Henry Ford Health System in Detroit.
Healthcare issues are also front and center heading into the 2020 presidential election with many Democratic contenders calling for expanding the Medicare program to more people than just the seniors who are currently eligible.
Former Acting CMS Administrator Andy Slavitt, who worked under President Barack Obama, said the 2018 elections showed that healthcare is moving up again on voters' agendas.
"For a long time, special interests have had a pretty loud voice," said Slavitt, who worked in the private sector, including at UnitedHealth's Optum unit, before taking the CMS job. "In 2018, people at grass roots got more organized."
Frustrated by the current system, calls for Medicare for All have become more mainstream with many Democratic presidential hopefuls backing the idea. But some are skeptical such a mammoth change would ever occur.
"Patients are paying more out of pocket and, news flash, they hate it," Michael Chernew, an economist at Harvard Medical School, said during the conference. But the reason Medicare for All stays on the front burner, he said, is overall frustration with the system.