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Levey writes: "Health insurers across the country are making plans to dramatically raise Obamacare premiums or exit marketplaces amid growing exasperation with the Trump administration's erratic management, inconsistent guidance and seeming lack of understanding of basic healthcare issues."

President Trump meets in February with the heads of major health insurers. Many industry officials and state regulators now believe they cannot rely on Trump to effectively manage the country's insurance markets. (photo: AFP/Getty)
President Trump meets in February with the heads of major health insurers. Many industry officials and state regulators now believe they cannot rely on Trump to effectively manage the country's insurance markets. (photo: AFP/Getty)


Heath Insurers and State Officials Say Trump Is Undermining Obamacare, Pushing up Rates

By Noam N. Levey, Los Angeles Times

19 May 17

 

ealth insurers across the country are making plans to dramatically raise Obamacare premiums or exit marketplaces amid growing exasperation with the Trump administration’s erratic management, inconsistent guidance and seeming lack of understanding of basic healthcare issues.

At the same time, state insurance regulators — both Democrat and Republican — have increasingly concluded they cannot count on the Trump administration to help them ensure that consumers will have access to a health plan next year.

The growing frustration with the Trump administration’s management — reflected in letters to state regulators and in interviews with more than two dozen senior industry and government officials nationwide — undercuts a key White House claim that Obamacare insurance marketplaces are collapsing on their own.

Instead, according to many officials, it is the Trump administration that is driving much of the current instability by refusing to commit to steps to keep markets running, such as funding aid for low-income consumers or enforcing penalties for people who go without insurance.

“All this uncertainty is not helpful,” warned Blue Shield of California Chief Executive Paul Markovich, who said health plans were being forced to make plans to raise premiums to account for the turmoil, jeopardizing Americans’ coverage.

Markovich was one of the few senior insurance officials who agreed to speak on the record, as many fear retribution from the White House or its allies.

But privately, many executives, including chief executives of major health plans, offered withering criticism of the Trump administration’s lack of leadership.

“It’s hard to know who’s home,” said one chief executive. “We don’t know who is making decisions.”

Another chief executive said: “There seems to be no coordination or coherent planning.… It’s a mess.”

A third official observed: “There is a sense that there are no hands on the wheel and they are just letting the bus careen down the road.”

Trump and GOP congressional leaders insist the marketplaces are collapsing because of flaws in the original law. They cite premium hikes in some states, and decisions by several insurers to stop selling Obamacare plans, including major national companies such as Humana and UnitedHealth Group. That has left some areas of the country with just one health plan option next year.

“Obamacare has failed,” said Alleigh Marre, a spokeswoman for the U.S. Department of Health and Human Services. “For this reason, Republicans are reforming healthcare so it delivers access to quality, affordable coverage to the American people.”

Several Republican state insurance commissioners also blamed weaknesses in the law for the current instability.

“There has been uncertainty with the Affordable Care Act since it started,” said Maryland Insurance Commissioner Al Redmer Jr. Maryland’s largest insurer, CareFirst, is seeking to raise rates by more than 50% next year.

But most health plans and state regulators interviewed for this story said the Trump administration has significantly exacerbated turmoil in the marketplaces in recent months, contributing to rising premiums and the threat of marketplaces exits.

“There is no consistency to the messages,” said Ceci Connolly, chief executive of the Alliance of Community Health Plans, whose members include leading health systems such as Kaiser Permanente and Geisinger Health Plan. “We are very confused.”

The Trump administration has sent mixed signals about whether it will enforce penalties on people who don’t buy health insurance. The penalty, though unpopular, is seen as crucial to inducing younger, healthier people to get coverage.

Trump and his deputies have also repeatedly threatened to withhold federal aid that helps millions of low-income Americans afford their deductibles and co-pays.

The aid, which reimburses insurers for lowering out-of-pocket costs, was paid by the Obama administration, but is now the subject of a lawsuit by congressional Republicans, who argue Congress must approve the payments.

The Trump administration hasn’t taken an official position in the lawsuit. But in recent months, the president publicly mused about stopping the payments to force Democrats to negotiate a repeal of the current law. It remains unclear whether the administration will continue the payments, known as cost-sharing reductions, or CSRs.

In a letter to Washington state insurance regulators this month, California-based Molina Healthcare, a leading provider of Obamacare plans in many states, warned halting CSRs may cause the collapse of the state’s market.

“If the federal government’s full CSR funding commitments are in jeopardy, we believe that the viability of the exchange market is in immediate jeopardy of failing,” wrote Peter Adler, who oversees Molina’s plans in Washington.

The uncertainty created by Trump comes as some Obamacare markets were beginning to stabilize, according to many industry and government officials. In several states, insurers and regulators noted that 2017 was shaping up to be a better year than the first several years of the marketplaces.

Tennessee Blue Cross Blue Shield Chief Executive J.D. Hickey reported in a letter to that state’s insurance commissioner this month that “our 2017 performance has improved due to a combination of better claims experience and more sustainable rate structure.”

Hickey warned in the letter that “potential negative effects of federal legislative and/or regulatory changes,” including not paying CSRs or enforcing the mandate, would require the Tennessee plan “to price-in those downside risks.”

Many state insurance regulators are similarly dismayed by the Trump administration’s actions, which Washington state Insurance Commissioner Mike Kreidler compared to playing Russian roulette with Americans’ health insurance coverage.

“It’s ludicrous,” said Kreidler, who is a Democrat. “This has real impact on people’s lives.”

In Colorado, where most consumers continue to have multiple insurance choices, commissioner Marguerite Salazar said the Trump administration threatens the whole market. “My fear is it may collapse,” she said.

Mississippi Insurance Commissioner Mike Chaney, a Republican, is so concerned the turmoil will drive away insurers that he’s exploring whether the state can make available limited benefit insurance plans as a stopgap.

The plans would likely cap medical care and prescription drug coverage. But Chaney said, “It would be better than nothing.”

Insurance industry officials and state regulators have met repeatedly in recent months with senior Trump administration officials in an effort to explain that administration’s actions are jeopardizing health coverage for millions of Americans.

But in many cases, the meetings only left insurers and regulators more confused about the administration’s plans, according to attendees.

At one recent meeting, Seema Verma, whom Trump picked to oversee the federal Medicare and Medicaid programs, stunned insurance industry officials by suggesting a bargain: The administration would fund the CSRs if insurers supported the House Republican bill to repeal the Affordable Care Act.

“It made no sense,” said one official at the meeting.

Many insurers, as well as every leading patient and physician group, believe the House bill is deeply flawed. Independent analyses suggest the legislation, which Trump has enthusiastically backed, would increase the ranks of uninsured by 24 million over the next decade.

Trump administration officials denied Verma suggested the administration would fund the CSRs. “What she said at the ... meeting in April was that no decisions had been made about CSRs,” said Jane Norris, a spokeswoman for the Centers for Medicare and Medicaid Services, who according to the agency also attended the meeting.

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-12 # lnason@umassd.edu 2017-05-19 11:11
Trump may be exacerbating the situation a bit but these trends were already obvious to any observer long before Trump was seen to be a possible president. All last year, premiums and co-pays and deductibles soared, healthcare networks narrowed, insurers left marketplaces, co-ops went bankrupt, rural hospitals closed, employer-provid ed plans got skimpier, fewer doctors accepted Medicare/Medica id patients, etc., etc. The ACA was a negative for about 80% of Americans and Democrats would do better with the electorate if they acknowledged this instead of falsely claiming that band aids could correct the problems.

Lee Nason
New Bedford, Massachusetts
 
 
+3 # lfeuille 2017-05-19 23:45
Yes, the trend was there, but it was a slow trend, not an avalanche. Left alone, it would have provided time for a change in administration and a chance for real reform, single-payer, not a return to the pre-ACA status quo.
 
 
+2 # Femihumanist 2017-05-19 12:39
I don't often agree with you but you're right. ACA was doomed from the time it was passed. There was no way the insurance industry was going to slack on their lust for money and no way the Congress would have met their demands.

Get the insurance industry out of Healthcare (except for those people who opt out of Single Payer and choose to go private). Once and for all, the US should just catch up to the world.
 
 
+5 # reiverpacific 2017-05-19 14:00
I hate to keep repeating myself but single-payer, everybody in, nobody out (except for insurance companies, who should NEVER be part of any public health equation) is the ONLY viable solution.
It seems further away than ever under Drumpf/Ryan(d) however, one of the best reasons for speedy impeachment, include holy-roller Pence.
 
 
0 # Femihumanist 2017-05-22 15:03
[quote name="reiverpacific"]
It seems further away than ever under Drumpf/Ryan(d) however,

Maybe I'm too optimistic, but if we survive Trump until we are finally rid of him one way or the other, single-payer may be much closer than it otherwise would have. Hopefully, the backlash will be overwhelming and we won't just go back to business as usual.
 

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