Health­care lead­ers down­beat on com­pro­mise ACA fix bill

Modern Healthcare - - NEWS - By Mer­rill Goozner

PAR­ADISE VAL­LEY, Ariz.—Health­care lead­ers gath­ered for Mod­ern Health­care’s sec­ond an­nual Lead­er­ship Sym­po­sium have grown pes­simistic about the prospect for pass­ing leg­is­la­tion that would sta­bi­lize the in­sur­ance ex­changes for next year’s open en­roll­ment sea­son—now just two weeks away.

Pres­i­dent Don­ald Trump’s sud­den re­ver­sal on sup­port­ing the leg­is­la­tion crafted by Sens. La­mar Alexan­der (R-Tenn.) and Patty Mur­ray (D-Wash.) cast a pall over a meet­ing where nearly 100 top of­fi­cials dis­cussed lead­er­ship chal­lenges dur­ing a time of “dis­rup­tion, com­plex­ity and un­cer­tainty.”

“The pres­i­dent had six dif­fer­ent per­spec­tives on Mur­ray-Alexan­der within the course of 48 hours,” said Dr. Bruce Siegel, CEO of Amer­ica’s Es­sen­tial Hos­pi­tals. “I don’t see how this Congress passes some­thing that fixes the ACA and goes back to its con­stituents and fun­ders.”

“Is Alexan­der-Mur­ray dead? Do you mean to­day? To­mor­row I’m go­ing to give you a dif­fer­ent an­swer,” said Joseph Swedish, CEO of An­them, the na­tion’s sec­ond largest pri­vate health in­surer. “It had a lot of mo­men­tum and cap­tured the at­ten­tion of a lot of peo­ple. I pray that it can hap­pen. (But) the ide­o­log­i­cal di­vide stands in the way.” The com­pro­mise leg­is­la­tion would con­tinue for two years the cost-shar­ing sub­si­dies for low- and moder­ate-in­come fam­i­lies pur- chas­ing plans on the ex­changes while giv­ing states more flex­i­bil­ity to craft rules gov­ern­ing their ex­changes and Med­i­caid ex­pan­sions. Trump can­celed the sub­si­dies last week.

Chances of pass­ing the bill—crafted to ap­peal to moder­ates in both po­lit­i­cal par­ties—faded quickly once Repub­li­can lead­ers in both houses of Congress threw cold wa­ter on the com­pro­mise bill, which so far has drawn just 11 co-spon­sors from the ma­jor­ity Repub­li­cans in the Se­nate. Con­ser­va­tives in the House, in­clud­ing Speaker Paul Ryan (R-Wis.), re­main stead­fastly op­posed to what they call a bailout for the in­sur­ance in­dus­try.

Iron­i­cally, the net ef­fect of can­cel­ing the in­di­vid­ual cost-shar­ing sub­si­dies could be lower out-of-pocket pre­mi­ums for most plan pur­chasers, which could spur en­roll­ment if word gets out. Gov­ern­ment pay­ments to in­sur­ers for the core pre­mium, which can­not be ended by ex­ec­u­tive or­der, will rise to cover the higher cost of poli­cies ne­ces­si­tated by can­cel­la­tion of the cost-shar­ing, health in­sur­ance ex­perts pre­dict.

In­sur­ers are not tak­ing so­lace from that pos­si­bil­ity, since in­sta­bil­ity in the in­di­vid­ual in­sur­ance mar­ket has made it dif­fi­cult to pre­dict med­i­cal losses and set ac­tu­ar­i­ally sound rates.

“Sta­bil­ity of fund­ing is crit­i­cal,” Swedish said. “A lot of gam­ing is go­ing on. Twenty per­cent of our ACA mem­bers don’t hold in­sur­ance for more than six months.”

Providers at the con­fer­ence also aimed fire at the pres­i­dent’s ex­ec­u­tive or­der that opened the door to the re­turn of as­so­ci­a­tion health plans and length­ened to one year the time in­di­vid­u­als can pur­chase plans that do not meet ACA rules like cov­er­ing peo­ple with pre-ex­ist­ing med­i­cal con­di­tions.

Most an­a­lysts be­lieve that or­der, which was greeted with cau­tious ap­proval by some in­sur­ers, will cre­ate an­other op­tion for healthy peo­ple will­ing to risk skimpy cov­er­age to es­cape the ACA ex­changes, which will drive rates in those mar­ket­places higher.

“It brings back the Wild West,” said Chip Kahn, CEO of the Fed­er­a­tion of Amer­i­can Hos­pi­tals, which rep­re­sents the for-profit hos­pi­tal in­dus­try.

Kahn did hold out hope that the year-end dead­line for pass­ing leg­is­la­tion to pre­vent a gov­ern­ment shut­down pro­vides an op­por­tu­nity for some much-needed health­care bills to pass, in­clud­ing the Chil­dren’s Health In­sur­ance Pro­gram.

But the cost-shar­ing sub­si­dies may be the bridge too far for con­ser­va­tive Repub­li­cans in the House, many of whom could face pri­mary chal­lenges next year from well-funded tea party-style can­di­dates ve­he­mently op­posed to the ACA.

“The ques­tion is how much pain has to be ex­pe­ri­enced by how many peo­ple be­fore we get to the point where the eco­nomic and hu­man­i­tar­ian ef­fects forces ac­tion,” said Dr. James Madara, CEO of the Amer­i­can Med­i­cal As­so­ci­a­tion.

LOVELEE PHO­TOG­RA­PHY

From left, Chip Kahn, Dr. James Madara, Dr. Bruce Siegel and Joseph Swedish dis­cuss what to ex­pect next in the fight over the ACA dur­ing a panel at Mod­ern Health­care’s Lead­er­ship Sym­po­sium.

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