Photo courtesy of AHIP
America’s Health Insurance Plans CEO Marilyn Tavenner says that despite struggles in the Affordable Care Act marketplaces, the insurance industry remains strong thanks to robust growth within government-sponsored plans.
In a conversation with Politico’s "Pulse Check," Tavenner touched on the implications of two major mergers currently facing a Department of Justice lawsuit seeking to block the deals, as well as her own transition from the Centers for Medicare & Medicaid Services (CMS).
She said AHIP's biggest challenges still revolve around delivery system reform and affordability--both of which were key issues that brought her to AHIP after a three-year term as administrator of CMS.
Though Medicare Advantage and Medicaid managed care have been lucrative for insurers, Tavenner admitted that some “didn’t get their pricing right” during the first three years of the ACA exchanges, but she added that many carriers were still trying to grasp the individual markets and believed risk corridor funding would be available to cushion the blow. Designing plans--specifically deductibles and co-pays--that are worthwhile to younger, healthier individuals will be a key to stabilizing the exchanges, she noted.
She said the premium spikes expected during this year’s open enrollment period represent “a bit of a catchup” from the last several years of taking on sicker-than-expected patients.
“I hope it's a one-time correction because none of us want to be in that environment,” she said.
Tavenner also praised CMS' Medicare Part B demonstration project, saying it “makes perfect sense,” but argued the agency should include Medicare Advantage plans as part of its proposal to control pharmaceutical costs.
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