Worried About Changes to the ACA? So Are the Top State Insurance Commissioners
The first rollout of the Trump administration’s bill to repeal the Affordable Care Act won’t pass muster, at least according to the GOP commissioner in charge of state health regulation.
“It ultimately will not be, in my opinion, the proposal that eventually passes – if something passes,” said Maryland Insurance Commissioner Al Redmer Jr. to a conference hosted by America’s Health Insurance Plans.
Redmer, the chairman of the National Association of Insurance Commissioners’ health insurance committee, said he and Wisconsin Insurance Commissioner Ted Nickel, this year’s president of the NAIC, agree that one proposal for the ‘Republicare’ plan, selling health insurance across state lines, simply won’t work.
Former House Speaker Newt Gingrich also addressed the attendees at the AHIP luncheon, and he told the audience that the House of Representatives is held back from putting legislation forward to “repeal and replace” the ACA due to filibuster rules in the Senate.
“So you end up with a bill that’s, in some ways, a little bit deformed by the legislative requirements,” Gingrich said.
The more conservative wings of the Republican Party from the Freedom Caucus to Tea Party adherents have expressed hostility the first round of Republican bills. They say the initial bills contain what they call “entitlements.”
Gingrich said there could be as many as 10 Republican Senators from moderates to conservatives, who now oppose the legislation as it was rolled out. Gingrich noted that there are 52 Republicans in the Senate, and he added that Democrats are not expected to support the first ‘Republicare’ legislation as it’s now written. Gingrich did hold out hope that some form of repeal and replace action will move forward.
“It’s very unlikely that a president as willful, as intelligent and as energetic as Trump is going to lose his first big bill. I will stipulate right now, something will be signed into law. I don’t have a clue what it will look like,” Gingrich said. “I actually don’t think they do either because they’ve got to wait and see how the pressure cooker works.”
According to Redmer, the difficulty lies in attempting to build health-care “provider networks” in different areas. Both of the insurance commissioners said that while they welcome the proposal’s increased reliance on state regulatory authority over insurance markets, they remain steadfast in their support for high-risk pools which cover people with medical problems.
Redmer told the assembly it would be a mistake to preempt or eliminate “our ability in the states to protect our consumers. There are already opportunities for carriers to do business around the country. You just have to abide by the rules of that state, and any environment that would create a race to the bottom of gutted consumer protections is something that I would be concerned about.”
“You’re not going to buy an insurance policy in rural Iowa – and live in Maryland – and have your health care delivered at Johns Hopkins University without having the same cost of delivering that care,” Redmer said.
Nickel and Redmer favor providing more funding for states willing to return to state high-risk pools for people with medical problems. Those parameters were in force in some 35 states before the ACA kicked in during 2014.
Nickel pointed to Wisconsin’s previous high-risk pool program as a model for changes following the ACA battle. According to Nickel, consumers who were rejected for coverage were eligible for subsidized policies. He added that costs associated with those subsidies were shared by consumers who purchased commercial plans, by providers and by insurers. That plan allowed people to use their plans statewide with no network requirements.
According to Nickel, a high-risk pool in Wisconsin prior to the ACA was functioning well, but that it had to be dismantled when alternative exchanges and subsidies became available. Nickel said some 90 percent of consumers in Wisconsin already had access to affordable health care before the ACA. He added that the number of consumers with that access has grown following adjustments made to accommodate the ACA rules.