Sebelius: Uncertainty could undo Affordable Care Act without repeal

April 06--Former Kansas Gov. Kathleen Sebelius says that even if President Donald Trump and Republicans in Congress can't repeal the Affordable Care Act, they can unravel the health insurance marketplace just by keeping people guessing.

Sebelius, a Democrat, was in charge of implementing the law commonly known as "Obamacare" when she served as secretary of the U.S. Department of Health and Human Services from 2009 to 2014.

She said uncertainty about whether the law will change and whether the Trump administration will continue to enforce it is already making insurers reconsider whether to offer federally subsidized plans to Americans who don't get health insurance through an employer or the government.

"I think they can actually do a pretty good job collapsing the marketplace that now has 12.2 million people enrolled by just not clarifying what the rules are," Sebelius said in an interview before she spoke Wednesday at the Center for Practical Bioethics' annual dinner.

"Because no insurance company will enter a market where they really don't know if they have customers, if they will be paid back the money that they have to front for the subsidies, if the rules that they understand and know about are going to stay in place."

Insurers have to submit their initial premium rate requests for 2018 plans to state regulators in about two months.

It was already difficult for them to decide which states to sell plans in and how to set rates in new marketplaces with consumers who in some cases hadn't been insured in years. It's even harder in a regulatory environment that threatens to change almost daily.

Minnesota-based Medica started offering plans in Kansas this year. But Medica spokesman Greg Bury said the company was re-evaluating its offerings again Thursday following news that a competitor, Aetna, was pulling out of Iowa.

"We entered new markets with the intention of being a part of those markets for a long time to come," Bury said. "That remains our goal. Given all the uncertainty right now, all we can say is that we are currently evaluating the situation and our options."

One of Trump's first moves as president was to issue an executive order instructing federal agencies to ease off on Affordable Care Act regulations.

After House Republicans failed to bring a repeal-and-replace vote to the floor last month, Trump said he hoped to get Democrats on board after the current health care law "explodes, which it will soon."

But House Republicans have since restarted talks on replacing the Affordable Care Act.

House Speaker Paul Ryan, a Republican from Wisconsin, said on the NPR program "Indivisible" Wednesday night that the GOP is looking for a plan that lowers premiums and out-of-pocket costs while still protecting people with pre-existing conditions.

At a news conference Thursday morning, Ryan said Republican leaders will add a national "high-risk pool," for people who are difficult to insure because of their medical needs, to the American Health Care Act that failed to get a vote.

"We have more work to do, and those conversations continue to take place, and they really show promise," Ryan said. "But this amendment alone is real progress and will help us build momentum for delivering on our pledge to the country."

Sebelius, also a former Kansas insurance commissioner, said that to provide certainty to the insurance market, major changes to current law should not go into effect until a date years in the future.

In the meantime, she said Trump and Congress should make it clear to insurers and customers that the federal subsidies will be paid, the penalty for Americans who don't carry insurance will stay in place and the federal HealthCare.gov website will continue to operate.

Failure in any of those areas could make the marketplace explode, Sebelius said.

"They own this puzzle right now," she said, "and the longer this uncertainty lasts, the more damage they can do to people who are relying on this for their health care."

Andy Marso: 816-234-4055, @andymarso

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