Obama’s health care law still needs some patch­work

The Sentinel-Record - - OBITUARIES - TOM MUR­PHY

The health care law of the land has sur­vived for now, but it needs help — and it needs it soon.

Soar­ing prices and fewer choices may greet cus­tomers when they re­turn to the Af­ford­able Care Act’s in­sur­ance mar­ket­places this fall, in part be­cause in­sur­ers are fac­ing deep un­cer­tainty about whether the Trump ad­min­is­tra­tion will con­tinue to make key sub­sidy pay­ments and en­force other parts of the ex­ist­ing law that help con­trol prices.

As­sur­ances don’t look to be com­ing any­time soon. “As I said from the be­gin­ning, let Oba­maCare im­plode, then deal. Watch!” Pres­i­dent Don­ald Trump tweeted early Fri­day, soon af­ter the Se­nate nar­rowly re­jected the lat­est push to dis­man­tle the Obama-era health care law.

Health and Hu­man Ser­vices Sec­re­tary Tom Price said in a state­ment af­ter the Se­nate vote that the Trump ad­min­is­tra­tion would pur­sue its health care goals through reg­u­la­tion.

That kind of un­cer­tainty rat­tles in­sur­ers, many of whom have al­ready stopped sell­ing poli­cies through pub­lic in­sur­ance mar­kets es­tab­lished by the health law be­cause they were los­ing money.

Their main con­cern now is that the Trump ad­min­is­tra­tion will stop pay­ing cru­cial sub­sides called for in the law that help re­duce costs like de­ductibles for peo­ple with low in­comes. The sub­si­dies, es­ti­mated at $7 bil­lion a year, have been chal­lenged by Repub­li­cans in court, and Trump has only guar­an­teed them through this month.

If they stop, in­sur­ers will have to raise prices for cov­er­age, known as pre­mi­ums, be­cause by law they must still of­fer the same re­duced de­ductibles for their low-in­come cus­tomers.

Leerink an­a­lyst Ana Gupte sur­veyed sev­eral states and has said that in­sur­ers are ask­ing for price hikes of around 36 per­cent when they as­sume the sub­si­dies go away, com­pared with about 18 per­cent if they stay.

Peo­ple with low in­comes might be shielded from these hikes in part be­cause the law pro­vides tax cred­its that cover much of the pre­mium.

But those who make too much to qual­ify for that help — and tend to vote Repub­li­can — could get hit hard, noted health care con­sul­tant Robert Laszewski, a for­mer in­sur­ance ex­ec­u­tive.

“(Trump’s) hurt­ing his own peo­ple,” Laszewski said.

Of course, all shop­pers will be hurt if in­sur­ers leave mar­kets, noted Ur­ban In­sti­tute health econ­o­mist Linda Blum­berg.

“Then there’s nowhere to use your sub­sidy,” she said.

The Blue Cross-Blue Shield in­surer An­them has al­ready with­drawn from mar­kets in Ohio, Wis­con­sin and In­di­ana. CEO Joseph Swedish said Wed­nes­day the com­pany may cut back fur­ther if it doesn’t get cer­tainty on the sub­si­dies “quickly.”

In­sur­ers have un­til the mid­dle of next month to fi­nal­ize their 2018 prices, in­dus­try of­fi­cials say. They must leave enough time for the rates to be sub­mit­ted to the mar­ket­places, and then for the on-line ex­changes that sell the cov­er­age to be tested be­fore en­roll­ment for next year’s plans be­gins on Nov. 1.

If in­sur­ers want to back out of a mar­ket, they have un­til about late Septem­ber to do so.

Op­tions al­ready have grown thin. About a third of the U.S.’s ap­prox­i­mately 3,000 coun­ties have only one in­surer sell­ing cov­er­age on their ex­change, which is the only place where shop­pers can get tax cred­its based on their in­come to help buy cov­er­age. Those cred­its are sep­a­rate from the sub­si­dies for low-in­come cus­tomers.

Nearly 40 coun­ties cur­rently have no choices for next year on their ex­changes.

Dan Men­del­son, pres­i­dent of the con­sult­ing firm Avalere, says there is some hope that the Trump ad­min­is­tra­tion could yet shore up the sys­tem. He thinks the ad­min­is­tra­tion could rec­og­nize that it will be held ac­count­able by vot­ers for the con­di­tion of the law’s mar­ket­places. Fur­ther de­te­ri­o­ra­tion “would be very neg­a­tive for them,” he said.

“I think in the end they’re go­ing to have to sta­bi­lize these mar­kets,” he said.

The As­so­ci­ated Press

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