Si­lence from health­care CEOs on AHCA pol­i­tics is deaf­en­ing

Modern Healthcare - - NEWS - By Shelby Liv­ingston

As law­mak­ers in Washington, D.C., con­tinue to wran­gle over ways to re­peal and re­place the Af­ford­able Care Act, a key group of stake­hold­ers has re­mained con­spic­u­ously silent: health­care CEOs.

Few health­care ex­ec­u­tives are wield­ing their in­flu­ence pub­licly to shape leg­is­la­tion now be­ing drafted in the Se­nate even though it will sig­nif­i­cantly af­fect their com­pa­nies’ bot­tom lines and their cus­tomers. In­stead, they seem to be re­ly­ing on in­dus­try lob­by­ing groups to carry the wa­ter. Their si­lence is a missed op­por­tu­nity to serve their pa­tients’ best in­ter­ests, some ex­perts say.

“Health in­sur­ance CEOs in par­tic­u­lar could be very in­flu­en­tial if they weighed in on whether the (Amer­i­can Health Care Act) would sta­bi­lize or desta­bi­lize the mar­ket,” said Larry Levitt, se­nior vice pres­i­dent at the Kaiser Fam­ily Foun­da­tion.

Just a hand­ful of CEOs have raised con­cerns about the GOP bill, which passed in the House May 4, and the un­cer­tainty caused by the Trump ad­min­is­tra­tion’s ef­forts to un­der­cut the ACA.

Paul Markovich, CEO of Blue Shield of Cal­i­for­nia, for ex­am­ple, early this month blasted the AHCA for threat­en­ing to leave mil­lions more Americans unin­sured. After pro­claim­ing Oba­macare to be in a death spi­ral ear­lier in the year, Aetna CEO Mark Ber­tolini this month urged the Trump ad­min­is­tra­tion to give up re­peal­ing the law and fix it in­stead.

New Hyde Park, N.Y.based North­well Health’s CEO, Michael Dowl­ing, told the New York Times that the GOP bill would drown hos­pi­tals that serve low-in­come pa­tients. And Dr. J. Mario Molina, re­cently ousted as CEO of Med­i­caid in­surer Molina Health­care, crit­i­cized the leg­is­la­tion for threat­en­ing to raise pre­mi­ums and fur­ther desta­bi­lize the in­di­vid­ual in­sur­ance mar­ket.

But th­ese can­did ex­ec­u­tives are rar­i­ties. Else­where in the in­dus­try, it’s crick­ets, de­spite warn­ings from health pol­icy ex­perts who say the AHCA could leave more than 20 mil­lion Americans without health in­sur­ance.

“There’s been a less­en­ing of CEOs speak­ing out who should be speak­ing out,” said Bill Ge­orge, a se­nior fel­low at the Har­vard Busi­ness School who was CEO of med­i­cal-de­vice maker Medtronic from 1991 to 2001. “But I think (CEOs) have an obli­ga­tion be­cause it’s go­ing to have such a dra­matic ef­fect on ev­ery­one’s busi­ness.” A spokes­woman for Amer­ica’s Health In­sur­ance Plans, the in­sur­ance in­dus­try’s largest lob­by­ing group, said sev­eral health plans have pro­vided their per­spec­tive on health­care re­form. But “what’s more im­por­tant is that health plans are speak­ing with one voice about how the AHCA would im­pact those who rely on Med­i­caid or the in­di­vid­ual mar­ket for cov­er­age, and the im­prove- ments we rec­om­mend.”

It is pos­si­ble CEOs have gone mum out of fear, Ge­orge said. Pres­i­dent Don­ald Trump sent the shares of Boe­ing and Lock­heed Martin tum­bling after crit­i­ciz­ing the com­pa­nies via Twit­ter.

“A lot of CEOs that I know are fear­ful of a Trump tweet,” said Ge­orge, who has served on the boards of com­pa­nies in­clud­ing the Mayo Clinic and No­var­tis.

Molina told Mod­ern Health­care that his oust­ing from the com­pany his fa­ther built could have a “chill­ing ef­fect” on health­care ad­vo­cacy. The Trump ad­min­is­tra­tion and the Repub­li­can-con­trolled Con­gress have the power to dis­rupt health­care com­pa­nies’ busi­ness mod­els, and in­sur­ers are re­ly­ing on tax­payer-funded govern­ment pro­grams as an in­creas­ing por­tion of their rev­enue. Med­i­caid makes up 20% and Medi­care Ad­van­tage ac­counts for 12% of in­sur­ers’ to­tal pre­mium rev­enue in ag­gre­gate, ac­cord­ing to rat­ings firm S&P Global.

The in­di­vid­ual in­sur­ance mar­ket, on the other hand, rep­re­sents a small slice of in­sur­ers’ rev­enue—less than 10% of to­tal pre­mium rev­enue.

The stakes are high for health in­sur­ers and their pa­tients. In­sur­ers are busy de­ter­min­ing in­di­vid­ual in­sur­ance rates for 2018. In the five states that have pub­lished 2018 rates so far—Con­necti­cut, Mary­land, Ore­gon, Ver­mont and Vir­ginia—and the Dis­trict of Columbia, in­sur­ers con­sis­tently asked for dou­ble-digit rate hikes with some re­quests ex­ceed­ing 50%.

Those 2018 rates could climb even higher if the fed­eral govern­ment doesn’t take steps to ease in­sur­ers’ jit­ters over ACA re­peal-and-re­place ef­forts, in­sur­ers said.

“This is a very se­ri­ous sit­u­a­tion. Just as peo­ple are ad­just­ing to the ACA, now we’re go­ing to have the AHCA, and (com­pa­nies) don’t know what’s go­ing to be in there,” Ge­orge said. “CEOs have to be en­gaged. I don’t think they have a choice.”

Dr. J. Mario Molina told Mod­ern Health­care that his oust­ing from the com­pany his fa­ther built could have a “chill­ing ef­fect” on health­care ad­vo­cacy.

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