After the death last week of the Republican plan to replace the Affordable Care Act, U.S. House Speaker Paul Ryan declared that the ACA was the law of the land for the foreseeable future. But that future is murky, with more reform attempts expected.
At least one insurance company, Anthem, announced earlier this month that without significant changes, it would start bailing from individual state marketplaces.
Anthem’s announcement came in the form of a March 9 letter from CEO Joseph Swedish to Republican leaders in Congress. Swedish said Anthem would start to “surgically extract” itself from individual insurance exchanges in 2018 unless lawmakers take action to stabilize the market.
A company spokesman declined to comment for this story and could not specify whether Maine would be included in the initial extraction.
Independent health policy consultant Mitchell Stein says Anthem’s position is understandable.
“Anthem is behaving rationally given the market circumstances. Because they’re facing uncertainty,” he says.
And under this uncertainty, the company has to determine its rates for 2018 within the next couple of months. Stein says that’s why Anthem’s letter is asking for stability.
He says two things in particular would make a big difference. One is for the federal government to provide risk sharing, like the $100 billion stability fund proposed under the Republican replacement. That would have allocated money to states to use to lower insurance costs for consumers. And Stein says there’s something else that would help, called cost-sharing subsidies.
Cost sharing subsidies help consumers pay out-of-pocket expenses. During the Obama administration, Congress didn’t allocate funding for those subsidies, so the administration had to find them somewhere else.
The question, says Stein, is whether the Trump administration or current Congress will commit to the subsidies.
“To my mind, that’s the most important unknown we’re facing right now,” he says.
That’s a major question for Maine’s insurance co-op, Community Health Options, as well. CEO Kevin Lewis also wants to see policies that will drive younger, healthier people into the mix.
“Ensure that there is either a mandate or a true penalty for nonparticipation that reflects the actual costs of people staying on the sidelines, because that does affect the entire pool,” he says.
Though Lewis and Stein say the marketplace needs stability, they also agree that it’s not in danger of “exploding,” as President Trump has predicted.
Maine’s other insurer on the individual marketplace, Harvard Pilgrim, did not return a request for comment for this story.
