As the nation holds its breath in anticipation of the Republican Party's reform of health care reform, insurers have already moved into the hyperventilation stage.
The health insurance industry is one that, historically, has evolved by increments.
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Yet since the passage of the Patient Protection and Affordable Care Act, it has been asked to change by leaps and bounds. But now, with an incoming president and Congress that have vowed to undo the ACA with no replacement plan to offer, the industry doesn't know what to brace for next.
Outgoing President Obama neatly summed up the dilemma facing the nation in an interview with the media the other day. "If they can come up with something better that actually works, a year or two after they've replaced the ACA with their own plan, and 25 million people have health insurance and it's cheaper and better and running smoothly, I'll be the first one to say that's great," he said.
While there's been no shortage of criticism of the ACA's structure, most insurance authorities say its basic components were, in theory, solid. The ACA offered truly affordable health insurance to those with pre-existing conditions and others who, due to their age and other factors, were previously facing budget-busting insurance premiums—if they could get coverage at all.
The poor were finally able to "buy" basic coverage, and insurers' profits were somewhat protected by the "buy-or-pay-a-fine" law included to extract money from those who might not want coverage so that the subsidy pool could be filled.
Republicans say they intend to continue to offer affordable coverage to those with pre-existing conditions. (The poor will apparently be on their own again, at least based on current GOP statements.) But they do want to eliminate the "mandate."
But insurers fear that, without the stick of the mandate, the carrot of pre-existing coverage just won't work. And they will face the choice of either plummeting profits or escalating premiums—or both.
President-elect Trump and others in his party have floated various "solutions" to creating a mandate-less national health system. But insurers who spoke to The Hill poked large holes in all of them.
In a tweet reported by The Hill, the Kaiser Family Foundation's Larry Levitt laid out the challenge facing the GOP: "There is a bipartisan desire to guarantee insurance for pre-existing conditions. Sadly, there's no magic pixie dust that makes it easy."
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
