Are Republicans going to LET Obamacare die or MAKE it die? How can the individual market exchanges be stabilized?

“Mr. Trump declared that his plan was now to “let Obamacare fail,” and suggested that Democrats would then seek out Republicans to work together on a bill to bury the Affordable Care Act. If he is determined to make good on that pledge, he has plenty of levers to pull, from declining to reimburse insurance companies for reducing low-income customers’ out-of-pocket costs to failing to enforce the mandate that most Americans have health coverage.
“It’ll be a lot easier,” Mr. Trump said at the White House, adding: “We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us.” “ (A)

“It is true that the markets are looking shaky in some places. There are regions of Nevada, Indiana and Ohio where no insurers wish to offer Obamacare plans next year. In many other locations, competition has declined. And it appears that insurers are requesting hefty rate increases in many of the places they will stay.
But the Trump administration, rather than working to solve those problems, has mostly described them as failures of the previous administration. The White House has declined to say whether it will continue to pay certain subsidies to plans for very low-income Americans, subsidies seen as vital to the financial health of the exchange business. And it has suggested that it might decline to enforce the law’s individual mandate. Both of those actions will tend to raise prices, discourage insurer participation and make Obamacare shakier than it would be otherwise. (B)

There is “…..significant instability caused by the lack of commitment from the administration (or Congress) to fund the ACA’s cost-sharing reduction subsidies or to enforce the individual mandate.
The ACA requires insurers to cover cost-sharing subsidies to help low-income exchange enrollees pay out-of-pocket costs like deductibles and copays, with the understanding that they will be reimbursed by the federal government. However, these payments to insurers are currently subject to legal challenges, and the administration has been unclear regarding whether it intends to continue to fund them (or ask Congress to do so legislatively). Similarly, it is highly unclear whether the administration plans to enforce the law’s individual mandate, or whether they will actively support the marketing of policies during open enrollment.” (C)

“…. market stability is defined as the creation of a marketplace that both insurers and insureds will find worth participating in. This involves striking a balance between protecting insurers from the risks inherent in a market that is in transition and ensuring that consumers have access to meaningful and affordable coverage.”….” The CBO defines stability as “having insurers participating in most areas of the country and on the likelihood of premiums’ not rising in an unsustainable spiral.” (D)
To see a robust discussion on the five key considerations in achieving individual health insurance market stability, highlight and click on http://www.milliman.com/insight/2017/Five-key-ways-to-help-stabilize-the-inividual-and-small-group-health-insurance-markets-in-2018/?lng=1041

“The Senate health care bill appears to be dead—done in by the Republican Party’s inability to agree on a basic philosophical question: Should healthy Americans have to subsidize the sick?….The Republicans never resolved the fundamental question of how they should assist the sick. Instead, they tried to muddle past the issue with a series of murky compromises. Now, their entire seven-year quest to repeal Obamacare seems to have sunk under the weight of that indecision.” (E)

U.S. Sen. Lamar Alexander (R-Tenn.) today released the following statement:
“My main concern is doing all I can to help the 350,000 Tennesseans and 18 million Americans in the individual market who may literally have no options to purchase health insurance in 2018 and 2019. However the votes come out on the health care bill, the Senate health committee has a responsibility during the next few weeks to hold hearings to continue exploring how to stabilize the individual market. I will consult with Senate leadership and then I will set those hearings after the Senate votes on the health care bill.” (F)

(A) ‘Let Obamacare Fail,’ Trump Says as G.O.P. Health Bill Collapses, by Thomas Kaplan, https://www.nytimes.com/2017/07/18/us/politics/republicans-obamacare-repeal-now-replace-later.html
(B) Obamacare’s Future Now Depends on an Unhappy White House, by Margot Sanger-Katz, https://www.nytimes.com/2017/07/18/upshot/obamacares-future-now-depends-on-an-unhappy-white-house.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(C) To promote stability in health insurance exchanges, end the uncertainty around cost-sharing and other rules, by Erin Trish, Loren Adler, and Paul B. Ginsburg, https://www.brookings.edu/blog/up-front/2017/04/20/to-promote-stability-in-health-insurance-exchanges-end-the-uncertainty-around-cost-sharing-and-other-rules/
(D) Five key ways to help stabilize the individual and small group health insurance markets in 2018, by Lindsy Kotecki and Hans K. Leida,, http://www.milliman.com/insight/2017/Five-key-ways-to-help-stabilize-the-individual-and-small-group-health-insurance-markets-in-2018/?lng=1041
(E) The Controversy That Finally Killed the Senate Health Care Bill, by Jordan Weissmann, http://www.slate.com/blogs/moneybox/2017/07/18/the_controversy_that_finally_killed_the_senate_health_care_bill.html
(F) Chairman Alexander Statement on Senate’s Work on Individual Health Insurance Market, https://www.help.senate.gov/chair/newsroom/press/chairman-alexander-statement-on-senates-work-on-individual-health-insurance-market-

 

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