While debate continues regarding the repeal or revision of the Affordable Care Act (ACA), lawmakers need to reassure insurance companies that their market will exist in 2018 and beyond, according to a health care law professor and writer.
"The health insurance industry depends upon stability," Timothy Jost, emeritus professor at the Washington and Lee University School of Law and member of the Institute of Medicine, told Patient Daily. "So it's really important that our representatives take all the necessary steps to stabilize that market. When there's all this talk about repeals, it's really turning these insurers off. They don't want to be in a market that's about to be destroyed."
Jost, also a consumer liaison representative to the National Association of Insurance Commissioners, is author of Health Care at Risk: A Critique of the Consumer-Driven Movement. He also blogged recently about a few exchange stabilization bills in Congress that he says represent a new GOP approach to the ACA.
Jost said that as things stand, the health care reform debate happening inside the Beltway looks anything but stable, with recent polls showing that supporters of President Donald Trump prefer to have the law repealed immediately.
"I think Republicans are looking really hard at it, but they really don't know what to do," he said.
“There are real dangers in any ideas lawmakers might have about ‘repeal and delay,’ Joseph Antos and James Capretta warned in a posting on the Health Affairs blog. Antos is the Wilson H. Taylor scholar in Health Care and Retirement Policy and Capretta is the Milton Friedman chair at the American Enterprise Institute (AEI). The two said repealing and then delaying replacement of the ACA carries too much risk of unnecessary disruption to the existing insurance arrangements between insurers and policyholders and would probably not produce coherent health care reform.
"The most likely end result of 'repeal and delay' would be less secure insurance for many Americans, procrastination by political leaders who will delay taking any proactive steps as long as possible, and ultimately no discernible movement toward a real marketplace for either insurance or medical services," Antos and Capretta wrote. "Congress should instead roll back elements of the ACA in the same legislation that moves U.S. health care more deliberately toward a functioning marketplace that is less dependent on federal coercion and control. This approach provides the best chance of constructing a replacement plan that moves decisively in a better direction without unnecessarily creating chaos during the transition."
More than a month after Trump took office, the Republican-controlled Congress appears to be laboring over what decision to make on a direction for the ACA. The Trump Administration recently ordered a halt to all ACA marketplace outreach, including advertising.
"Health care reform is a very, very complicated problem," Jost said. "And the reforms they are looking at right now are a very small part of that health care reform."
One problem is to ensure continuing coverage for more costly health insurance customers, including the elderly, those who are sick and women.
"I think we can look for higher premiums for those categories," Jost said.
Jost said under the ACA the balance has been maintained by requiring younger, healthier people, who can expect lower premiums to carry health insurance or face a tax penalty.
In fact, House Speaker Paul Ryan recently suggested that the new plan might include provisions by the federal government to reinstate high-risk pools to subsidize health insurance for at-risk patients who require more care.
Before tackling that issue, legislators need to reassure health insurance providers that their market won't go away, and that's best done through bipartisan action, Jost said.
"Republicans and Democrats need to talk together and decide together what they can do, what is the best thing that can be done to fix this," he said. "They need to figure that out."
