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Affordable Care Act still plagued by uncertainty

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WASHINGTON — The failed effort to overturn the Affordable Care Act has hardly erased doubts about the law’s short- and long-term viability.

Already, the Trump administration has suspended contracts with two companies that have helped thousands of people in nearly a score of cities get health insurance under the statute. In ending the $22 million contracts, the White House put a stop to ACA enrollment fairs and sign-ups in public libraries. The action is one of the scant signals of how an administration eager to dump Obamacare will handle its upcoming enrollment season.

In late July, just before the Senate came up short of enough votes for a “skinny repeal” of the law, President Donald Trump said during a briefing with ACA “victims” that “Obamacare has broken our health care system — it’s broken, it’s collapsing, it’s gone.”

Less visibly, however, the layer of the Department of Health and Human Services that directly supervises the Obama­care insurance exchanges and HealthCare.gov enrollment website has been undertaking most, if not all, of its customary operations. It staged its annual meeting in June, for example, with “navigators,” community organizations that help guide consumers toward ACA health plans. But continued funding for the groups was up in the air as of early this month.

And while Republicans now say they want to stabilize the exchanges for 2018, insurers say it may be too late. For months, they have cautioned that they need assurances from the federal government in order to choose where to sell Obama­care plans and what to charge for them. But their pleas will not be heard until Congress returns from its August recess on ­September 5.

Insurers must finalize premiums in most states by late August and ink final contracts for next year by the end of September. Already the fifth year of open enrollment is shaping up to have more premium increases, less choice of insurers and the potential for some 20 rural counties having no ACA plans at all.

A number of insurance companies and state regulators say that GOP policies and the doubts they created have erected new roadblocks just as the exchanges were starting to gain financial traction. Several health plans that announced 2018 exits from ACA markets cited their uncertainty over government action as the cause.

Some states have even allowed insurers to establish alternative premiums — with rates in some versions rising 10% or 20% if the White House cuts crucial payments. Trump has repeatedly threatened to end the payments, which offset insurers’ outlays for reducing deductibles, co-payments and other out-of-pocket costs for about 7 million low-income plan recipients.

“I am very fearful that we’ll have insurers make a decision to leave markets as a result of the uncertainty,” Julie Mix McPeak, Tennessee’s insurance commissioner and incoming president of the National Association of Insurance Commissioners (NAIC), told The New York Times, “It’s somewhat inequitable to ask insurers to sign a contract that binds them but may not bind the federal government.”

White House aides had said a decision would be made in late July or early August, but none was forthcoming.

“It’s entirely opaque to us,” McPeak was quoted as saying in The Washington Post. She said that she and colleagues have reached out to federal officials to try to discern which arm of the government would make the choice about the subsidies and when. “And we can’t get a clear picture,” she said.

NAIC chief executive officer Michael Consedine told The Times that lacking a firm promise of federal funds for the subsidies, “we have grave concerns about the long-term viability of the individual health insurance market in a number of states.”

“We need some step right away,” he said, “either by action of Congress or by direction of the administration, to ensure that Americans continue to have access to coverage.”

Sen. Ted Cruz (R., Texas) commented, “The solution to the Obamacare crisis is not simply billions of bailouts for giant insurance companies.”

Other GOP senators said they have tired of the issue. “We’re not going back to health care. We’re in tax [reform] now,” Orrin Hatch of Utah told Politico. “As far as I’m concerned, they shot their wad on health care and that’s the way it is. I’m sick of it.”

Majority leader Mitch McConnell (R., Ky.) said he prefers not to “dwell on situations where we come up a little bit short.”

Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.), the top members of the Senate Health, Education, Labor and Pensions Committee, announced that they will hold bipartisan hearings on stabilizing the market when they return to Washington. Their objective is to devise a plan that can take effect before insurers have to lock in 2018 rates.

And a bipartisan group of House members announced their own market stabilization plan. The proposal from the 40 or so members of the “Problem Solvers” includes funding the cost-sharing subsidies, easing the employer mandate and ending the medical device tax.


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