Past health chiefs: In­surance mar­ket sta­bil­ity is the goal

South Florida Times - - HEALTH - By Associ­ated Press Press. Associ­ated But Trump on Twit­ter and in in­ter­views has re­peat­edly threat­ened to pull the plug. Se­be­lius has been sharply crit­i­cal of the Trump ad­min­is­tra­tion's stew­ard­ship of the ACA.


WASHINGTON - Don't make things worse.

That's the ad­vice of for­mer U.S. health sec­re­taries of both par­ties to Pres­i­dent Don­ald Trump and the GOPled Congress, now that “Oba­macare” seems here for the fore­see­able fu­ture. The 2018 sign-up sea­son for sub­si­dized pri­vate health plans starts Nov. 1, with about 10 mil­lion peo­ple cur­rently served through Health­ and its state coun­ter­parts.

Sta­bil­ity should be the im­me­di­ate goal, said for­mer Health and Hu­man Ser­vices sec­re­taries Kath­leen Se­be­lius, Mike Leav­itt and Tommy Thomp­son. At min­i­mum: Dis­pel the po­lit­i­cal and le­gal un­cer­tainty - fueled by pres­i­den­tial tweets - around bil­lions in sub­si­dies for con­sumers' in­surance co­pays and de­ductibles. The three for­mer of­fi­cials shared their views with The

Beyond the ur­gent need to calm mar­kets by pro­vid­ing clar­ity on sub­si­dies, Demo­crat Se­be­lius and Repub­li­cans Leav­itt and Thomp­son dif­fer on the di­rec­tion Trump and Congress should take. They agree that Repub­li­cans still have an op­por­tu­nity to put their stamp on the Af­ford­able Care Act, even if the drive to “re­peal and re­place” for­mer Pres­i­dent Barack Obama's legacy pro­gram ap­pears to have hit a dead end.

“They can make changes that sig­nal a new ide­o­log­i­cal di­rec­tion with­out gen­er­at­ing a lo­gis­ti­cal and po­lit­i­cal mess,'' said Leav­itt, who led HHS dur­ing for­mer Pres­i­dent Ge­orge W. Bush's sec­ond term. “They won the right to make changes. How­ever, they should do it in a skill­ful way.” Leav­itt shep­herded the Medi­care pre­scrip­tion drug ben­e­fit through its rocky roll­out in 2006.

“Sta­bi­liz­ing the cur­rent sit­u­a­tion can only - I think - be to their ben­e­fit,” Se­be­lius said of the Trump ad­min­is­tra­tion. “In an en­vi­ron­ment in which (in­surance) com­pa­nies are en­rolling cus­tomers, they've got a lot of time to ac­tu­ally go back to the draw­ing board and fig­ure this out. The worst of all worlds for them would be to have the cur­rent sit­u­a­tion un­ravel be­cause of de­ci­sions by this ad­min­is­tra­tion.”

Se­be­lius helped steer Obama's law through Congress and later over­saw the trou­bled launch of Health­, when the com­puter sys­tem locked up on the first day of sign-up sea­son, frus­trat­ing mil­lions of con­sumers and em­bar­rass­ing the White House. She took the heat, but Se­be­lius stayed on task and ul­ti­mately helped de­liver a suc­cess­ful open en­roll­ment.

“It would be a mis­take to fur­ther desta­bi­lize the (in­surance) mar­ket,” said Thomp­son, who served dur­ing Bush's first term and led HHS prepa­ra­tions to meet the bioter­ror­ism threat after the deadly an­thrax mail­ings that fol­lowed closely the Sept. 11 at­tacks.

Thomp­son urged a health care sum­mit be­tween Trump and con­gres­sional lead­ers of both par­ties, fol­lowed by a pe­riod of in­ten­sive leg­isla­tive work un­der a dead­line to reach a truce in the po­lit­i­cal bat­tle over health care.

Trump and top lieu­tenants like HHS Sec­re­tary Tom Price have sent mixed sig­nals.

Lead­ing con­gres­sional Repub­li­cans want to try to move lim­ited leg­is­la­tion after law­mak­ers re­turn next month, wor­ried they'll suf­fer con­se­quences in next year's midterm elec­tions.

At the very least such leg­is­la­tion would pro­vide clear le­gal au­thor­ity for the ACA's cost-shar­ing sub­si­dies, which re­duce co­pays and de­ductibles for peo­ple with mod­est in­comes. Stop­ping the pay­ments would lead to a spike in pre­mi­ums, more in­sur­ers leav­ing the mar­kets and in­creased fed­eral deficits, the Con­gres­sional Bud­get Of­fice warned last week. The mar­kets al­ready saw steep pre­mium in­creases this year, and more in­sur­ers have since bailed out, cit­ing fi­nan­cial losses.

The ad­min­is­tra­tion has con­tin­ued to make monthly sub­sidy pay­ments to in­sur­ers, as re­cently as last week.

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