Health Insurers Say Whether ACA ‘Explodes’ Depends On Decisions Made Soon

March 31--Days after President Donald Trump said Obamacare will "explode," CEOs from major health insurers serving Florida met with Gov. Rick Scott. One company said this week it is "unable to make an informed decision" to participate in the 2018 Affordable Care Act marketplace until it knows what folks in charge intend to do.

House Speaker Paul Ryan is scheduled to talk to donors Friday morning at The Breakers in Palm Beach at a closed-door event. The agenda includes a "Healthcare Panel and Discussion," though a Ryan spokeswoman said he will not unveil a new health plan.

Choices and costs for millions of consumers ride on what happens next. The powwows come as insurers have to make decisions soon about whether to participate next year in ACA markets serving Florida and other states, and what rates they propose to charge. That process starts in May.

Momentum has stalled in the middle of a political minefield. The wheels came off an attempted GOP health rewrite last week. Talk since then has veered between moving on to other issues like tax reform and giving it another try.

Trump blasted both Democrats for not supporting the GOP health overhaul last week and his own party's conservative Freedom Caucus in a tweet Thursday: "The Freedom Caucus will hurt the entire Republican agenda if they don't get on the team, & fast. We must fight them, & Dems, in 2018!"

Short of a comprehensive health redo, Republicans are left with politically awkward options.

They can take actions to stabilize Obamacare, but that might appear to be an endorsement of a law that many including Trump campaigned on repealing and replacing. On the other hand, if they are seen as sabotaging the 2010 ACA by cutting off government money and not enforcing key regulations, that could hurt many of their own constituents, chase more insurers away and create a self-fulfilling prophecy of Obamacare's doom.

The question then becomes whether voters will blame a president no longer in office or the current administration and congressional majority whose hands are on the controls right now.

Polling indicated only 17 percent support for the failed GOP plan last week, the American Health Care Act.

The issue goes well beyond headline rate increases, which averaged 19.1 percent in Florida for plans now in effect in 2017. The sticker shock was taken out of those hikes for nine out of 10 of the roughly 1.5 million Floridians who buy plans on healthcare.gov because they get subsidies, or government financial assistance. Such help also can include "cost-sharing" assistance with deductibles.

While monthly premiums could and did jump for those making too much income to qualify for subsidies, they barely budged for most. More than 80 percent of Florida ACA customers still paid under $75 a month, according to the previous administration.

The Congressional Budget Office did not forecast a "death spiral" for the exchanges, even under big changes proposed in the GOP House bill.

What Republicans do next, though, directly affects costs and coverage for millions, according to people who recently oversaw Obamacare.

Two things would help reduce the cost of insurance 25 percent to 30 percent, said Andy Slavitt, former administrator for the Centers for Medicare and Medicaid Services from 2015 to 2017.

"First, the administration, with support from Congress, should commit to permanently funding payments that reduce the size of deductibles for lower-income Americans (called cost-sharing reductions)," Slavitt wrote in USA Today. "Republicans need to drop a lawsuit they filed to stop these payments, or Trump needs to say they are going to continue."

Second, Slavitt said, the administration should enforce the individual insurance mandate that requires people to buy health insurance or pay a penalty until a different approach can be agreed upon.

"Those two actions will reduce costs for millions and need to be done now before insurers submit initial premiums for next year, or inaction will drive up premiums," Slavitt said. "Americans should watch this intently."

Slavitt said he based the recommendations on a conversation with Mario Molina, president and CEO of Molina Healthcare.

Molina met Tuesday in Tallahassee with Florida Gov. Scott, who also talked later by phone with Florida Blue CEO Pat Geraghty.

"Dr. Molina met with Governor Scott today and had a cordial meeting with the primary discussion focused on Medicaid and the Health Insurance Marketplace," a Molina statement said. "Dr. Molina also asked Governor Scott how Molina Healthcare can help achieve our shared goals of making health care more affordable for the citizens of Florida."

The statement also noted: "Although the AHCA is off the table for now, we are currently unable to make an informed decision about whether to participate in 2018 in the individual marketplace without additional clarity on a couple of key issues. If cost-sharing reductions are removed or the individual mandate is not enforced, we still expect premiums to increase significantly, which will impact the viability of the marketplace. We are hopeful that Congress and the administration will take swift action to remove uncertainty for insurers by addressing these two important issues."

A spokesman for Scott said he "regularly meets with companies in Florida to discuss issues important to their business." He had no comment on specific proposals to bolster the health exchanges.

In recent months, Scott has spoken out forcefully for full repeal, not "tweaking" the current law. Scott said last week that politics are "messy" in Washington.

"I know Obamacare is spiraling out of control," he said. "Costs have been going way up."

The governor also said, "I want people to have access to health care."

Florida Blue had no immediate comment, but it and Molina were among seven health insurers who participated in ACA marketplace plans in Florida this year. Several competing insurers, including Aetna, bailed out.

Florida Blue confirmed it has been profitable in ACA market plans and had signed up close to 1 million people through the exchange by January.

"With the White House, the Senate and the House under the control of Republicans, the fate of the exchanges in 2018 is up to them," Slavitt said. "The ACA has provided a foundation that allows millions of Americans access to care. The focus should turn away from repealing it and toward what Americans now expect -- both parties working together to improve it."

Staff writer George Bennett contributed to this report.

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