Insurance execs influence health reform 2.0

Table with chairs around it
Executives including the CEOs of Molina Healthcare and Independence Blue Cross are hoping to shape what an ACA replacement looks like.

As Republicans begin the task of crafting an Affordable Care Act replacement, health insurance leaders are weighing in about what they’d like to keep, change and get rid of in the current law.

One such leader is Independence Blue Cross CEO Daniel Hilferty, who told Reuters that he’s been pushing for stricter restrictions on third parties that pay patients’ premiums and on special enrollment periods, priorities echoed by others in the industry.

What’s more, Hilferty said, insurers would like to play a more significant role in the enrollment process for individual marketplace plans rather than leaving it all in the hands of the state and federal exchanges.


2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

But the health insurance industry wants some aspects of the individual market to stay the same, at least for now.

America’s Health Insurance Plans has urged the new administration to fund programs like cost-sharing reductions and reinsurance at least through 2018. Insurers also want the ACA’s premium subsidies to stick around, Molina Healthcare CEO J. Mario Molina told Reuters.

RELATED: Fearing insurer exits, GOP mulls temporary subsidy funding

Backed up by President Donald Trump’s recent executive order, Republicans are likely to nix the ACA’s unpopular individual mandate, which levies a financial penalty on those who remain uninsured. But absent that mandate, policymakers must find a way to entice healthy individuals to buy insurance, Molina said, adding “it probably needs to be a combination of both an incentive and a penalty.”

For its part, AHIP has suggested incentives such as waiting periods for late enrollment, FierceHealthPayer has reported.

Another solution that some in the GOP have floated is bringing back high-risk pools, which allow insurers to offer lower prices for healthier enrollees. Many states had high-risk pools before the ACA, but Republicans’ updated version may not necessarily take a similar form, according to Dave Dillon, a fellow at the Society of Actuaries.

Suggested Articles

CMS Administrator Seema Verma said it will be crucial to have more conversations on how to address emerging—and expensive—therapies. 

The political jockeying over "Medicare for All" continued Wednesday as a House committee hosted a second hearing on single-payer healthcare.

Physician groups are moving, albeit slowly, to value-based payment, but there are still many obstacles standing in their way.