As Republicans consider paring back the Affordable Care Act’s federal mandates, they face a difficult question: What does health insurance need to cover?
The 2010 health law created a new set of federal requirements for plans sold to individuals and small businesses, including a list of 10 benefits, among them prescription drugs, mental-health services and laboratory tests. It also mandated that plans cover preventive services such as vaccinations at no cost to enrollees.
The rules, along with other minimum standards set by the law, were meant to ensure that consumers had strong protections and weren’t surprised by unexpected gaps or limits in their coverage. But that also contributed to making individual insurance more expensive in many cases.
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Everywhere you turn, health markets are nearing collapse. It’s an unfortunate and catastrophic reality of too much federal intervention in our health care. From soaring deductibles and skyrocketing premiums to fleeing insurers, it’s no wonder patients are paying more out of pocket each year under the so-called “Affordable Care Act.”
Today, the Energy and Commerce Committee’s Health Subcommittee will examine four legislative solutions to help deliver relief. Together, the bills will play an important role in being among the first bricks placed in the rebuilding of our health care system. Collectively, they will give patients relief from the law’s soaring costs, tighten enrollment gaps, and protect taxpayers.
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Part of why Obamacare is so unpopular is that it is neglects the typical American.
Obamacare is bad for the typical—or median—American for a variety of reasons, including: its unprecedented individual mandate; its inept manner of dealing with preexisting conditions, which has sent premiums soaring (by 40% over the past two years); its roughly $2 trillion price-tag (over a decade); and its consolidation and centralization of power and money at the expense of Americans’ liberty and their wallets. Rather than offering overdue tax breaks to everyone who buys his or her own health insurance, Obamacare instead gives direct subsidies to insurance companies (falsely labeled as “tax credits”) on behalf of the select few.
As Republicans deliberate over an alternative to Obamacare, this provides a huge opening. A more consumer-friendly system will go a long way towards reducing costs for all and bringing down overall health care spending.
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Insurers are generally confident they could manage the transition away from Obamacare and into a new replacement plan, according to a survey from the Urban Institute.
The group interviewed executives at 13 insurance companies participating in the individual market in 28 states to ask them how they would respond in various repeal scenarios proposed by the new administration. While all insurers said that uncertainty regarding the future of Obamacare is bad for business and for the stability of the individual market, they were confident they could manage policy changes. They also expressed optimism about a replacement plan that offered continuous coverage, which many Republican plans include.
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One of the stated aims of the Affordable Care Act was to increase competition among health insurance companies. That goal has not been realized, and by several different measures the ACA’s exchanges offer less competition and choice in 2017 than ever before. Now in the fourth year of operation, the exchanges continue to be far less competitive than the individual health insurance market was before the ACA’s implementation. Moreover, insurer participation in the law’s government-run exchanges has declined over the past two years and is now at the lowest level yet. This lack of insurer participation leaves exchange customers in 70 percent of U.S. counties with no insurer choice, or a choice between merely two insurers.
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The Republican congressional leadership has made a new timetable for gutting the Affordable Care Act, aiming to get legislation done by March or possibly April.
But that doesn’t give insurers much time to meet their first deadline for submitting plans for 2018 on the individual market, which includes the law’s exchanges.
A rule published four days before President Trump took office set the deadlines for insurers to sell health plans on the individual market, which is for people who don’t get insurance through their jobs. Democrats have charged that Republicans will throw the market into chaos by repealing the law without an alternative, with Republicans responding that the markets are already in turmoil.
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My colleague Avik Roy has suggested that passing a full Obamacare replacement (as opposed to a partial replacement passed via reconciliation) might be possible even though it would require Democratic votes to obtain the 60-vote threshold in the Senate, and that a pre-condition to achieving that would require the Congressional Budget Office (CBO) score the replacement as covering at least as many people as the Obamacare does.
As if to give a warning shot across the Republican bow, the officially non-partisan CBO warned that it “would not count those people with limited health benefits as having coverage” when evaluating changes to the health care law, and that changes to the “essential health benefits” required under the ACA could result in people receiving tax credits to help pay for health insurance under a new law, but being counted as not having health insurance according to the CBO, if the coverage they have doesn’t meet the CBO’s requirements. At issue, basically, is “What is health insurance?”
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Lanhee Chen, leading conservative health care expert, says, “There are a lot of people out there probably who assume that Republicans have no ideas on health care, because this has been the Democratic talking point for a long time. I think actually just the opposite is true. It’s not that we don’t have enough ideas as conservatives, it’s that we actually have too many. A lot of thinking and research has gone on the last several years around how you create a health care system that is more consumer friendly, that pays attention to costs first, that recognizes the importance of health care in people’s lives but doesn’t believe that the federal government is necessarily well-suited to make all of those important decisions.”
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Hundreds of insurers selling health plans in Affordable Care Act marketplaces are being paid less than 2 percent of nearly $6 billion the government owes them for covering customers last year with unexpectedly high medical expenses.
The $96 million that insurers will get is just one-fourth of the sum that provoked an industry outcry a year ago, when federal health officials announced that they had enough money to pay health plans only 12.6 percent of what the law entitles them to receive.
This time, the Obama administration made no public announcement.
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The head of America’s Health Insurance Plans, the national trade association representing health insurers, lists three key priorities for reform:
1. Commit to policies that support continuous coverage for everyone—those who utilize insurance to obtain quality care and those who are healthy but have insurance to protect them in case they get sick. Both types of consumers must be insured for coverage to remain affordable.
2. Commit to market stability in 2017 and 2019 by funding temporary, transitional funding programs at least through January 1, 2019.
3. Reduce health costs for millions of Americans by eliminating the health-insurance tax on insurers, which is passed along to employers and consumers in the form of higher premium costs.
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