House Republicans continue to work toward a health care deal but are currently in a holding pattern as they await further details from the Trump administration on proposed changes to the bill. “We don’t have bill text or an agreement yet,” Speaker Paul Ryan told reporters after meeting with the GOP conference Tuesday morning. He declined to discuss details of proposed changes, saying “productive conversations” were happening at the “conceptual level” regarding how to lower insurance premiums while maintaining “solid protections for people.” House Freedom Caucus members said the same thing Monday night after leaving a meeting where Vice President Mike Pence and Trump administration officials, including White House Chief of Staff Reince Priebus, discussed the proposed changes with them.
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One of the ill-fated bill’s greatest weaknesses was that it did not have a unifying purpose or goal. Was it about access or coverage? Cost or quality? Individual choice or collective responsibility? The answer was, effectively, a bit of each, due to congressional negotiations and the president’s pre-inauguration pronouncements. Canadian F.H. Buckley caused a maelstrom in conservative circles last week when he called on President Trump to advance a single-payer model for U.S. health care. The first step in any renewed effort to reform American health care is to define the objectives.
A second major health-insurer has decided to quit selling individual policies in Iowa, raising fears that tens of thousands of Iowans will have no options for coverage next year.
Aetna informed Iowa regulators Thursday that it had decided to stop selling such policies, which cover people who lack access to employer-provided coverage or government plans. The move would affect 36,205 customers, the company told regulators.
Aetna’s move takes effect in January. It came three days after Iowa’s dominant health-insurer, Wellmark Blue Cross & Blue Shield, announced that it would no longer sell individual health-insurance policies in Iowa.
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More insurance companies around the country are refusing to pay brokers commissions on higher-tier exchange plans or special enrollment sales as the companies face financial losses on the federal marketplace. “It’s the Wild West out here, and companies are doing what they can to survive,” says Ronnell Nolan, CEO of Health Agents for America, which represents independent insurance brokers. “They’re not paying commissions on platinum plans, and they are not paying them for special enrollment plans which cover some of the sickest patients.” An exodus of brokers from the federal marketplace could undermine enrollment efforts since brokers historically sign up at least 50% of exchange enrollees.
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The deal House Republicans reached on Thursday addresses a key problem with their alternative to the Affordable Care Act: steep premiums. The provision, which House Republicans decided to add to their Obamacare replacement bill before they face constituents during the Easter recess, would dole out $15 billion to states over about a decade to help insurers cover the sickest people in the health care system and reduce premiums for individual health plans.
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It looks like House Republicans have been trying over the past few days to coalesce around a revised version of the AHCA. One key revision has involved a more assertive temporary federal reinsurance scheme to quickly lower premiums and stabilize the transition period to a new system. But maybe the most significant, and least familiar, new proposal has involved allowing states to obtain waivers from some Title I regulations in Obamacare. The devil will be in the details, and they will matter enormously here, but the general concept of returning regulatory power to the states through waivers that are connected to the bill’s spending measures is an interesting way to deal with the constraints Republicans confront and could have real promise.
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