Health insurers are anxiously waiting for Republican leaders in Congress to offer specific plans on how they will fulfill their six-year promise to repeal the Affordable Care Act.
More importantly, the health industry is waiting to see how the GOP intends to repeal the landmark law in a way that won't leave millions of Americans uninsured and won't leave the insurers that currently are getting paid to cover them in a financially disastrous position.
Republicans have floated the idea of phasing out the ACA marketplace gradually, allowing current beneficiaries to keep their plans for another year or two as Congress devises a new system to put in place.
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But the assurance of an incremental implementation hardly assuages concerns about the immediate effect of repeal. Experts believe that many insurers that are currently offering plans on the marketplace will leave if they know that it will only exist for another two years.
"The discussion right now about repeal and replacement is making the market very, very nervous," Washington Insurance Commissioner Mike Kreidler, a Democrat, tells Politico. "I would not be surprised to see the potential for a stampede to exit the market."
ACA opponents have argued that the benefits of the ACA marketplace are overstated, and that the roughly 14 million people who get coverage through Healthcare.gov won't necessarily be sad to lose their plans, which critics have highlighted tend to be high-deductible, narrow network plans.
While President-elect Donald Trump's statements since the election suggesting he wants to keep certain provisions of the ACA have been widely interpreted as a partial surrender on his part, none of the positions he has taken would protect the marketplace from collapsing.
For instance, barring insurers from denying coverage based on pre-existing medical conditions — an ACA provision Trump supports — is made possible by the individual insurance mandate, which Trump and other Republicans say they oppose. Without a mandate, even fewer young, healthy people will sign up for coverage on the marketplace, making it even less attractive to insurers.
It is not clear what powers states have to force insurers to remain in the marketplace, but Politico reports some state officials, as well as Obama administration officials, are in talks with insurers about how to prevent the worst.
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