The payer-provider divide over Republicans' AHCA plans

Payers have been more reserved in their response to AHCA than providers.

Insurers and insurance executives have been mostly mum on the American Health Care Act and its CBO score, a response that stands in stark contrast to providers and other industry groups.

A few payers have commented on the legislation, and just one major industry group has issued a response following the Congressional Budget Office’s Report, which predicts that the AHCA in its current form would cause 23 million people to lose insurance coverage by 2026.

Provider groups, however, have broadly and loudly panned the bill from the get-go. 

RELATED: CBO details AHCA impact on marketplace premiums; industry calls on Senate to preserve ACA coverage gains. 

Association for Community Affiliated Plans (ACAP) CEO Margaret A. Murray said in statement that the CBO score confirms what the industry already knew.

“This bill would force states to choose between denying care to people who need it and vastly expanding their budgets,” Murray said.

“There are opportunities all around us to improve the healthcare system. We hope the deliberations in the Senate represent a fresh start, and look forward to engaging in more productive bipartisan conversations to enhance quality, preserve access, and control costs.”

Despite a quieter public response from the insurance side, payer industry groups are taking policy actions that at least offer a taste of insurers’ goals as stakeholders in the ongoing health reform debate. America’s Health Care Plans (AHIP) submitted a letter (PDF) to Senate Finance Committee Chairman Orrin Hatch, R-Utah, on Tuesday outlining policy suggestions for that chamber’s version of the healthcare bill.

In it, Marilyn Tavenner, AHIP's president, noted that the GOP plan has several provisions that would likely stabilize the individual healthcare markets in the short term.

But to ensure long-term stability, the federal government must fund cost-sharing reduction payments and enhance credits for younger enrollees to entice them into the market. The group called for immediate funding to CSR payments. 

The Trump administration was recently granted a 90-day stay in its lawsuit over the payments, which will ensure they’re funded at least in the very short term.

RELATED: Health insurers get 90-day stay in House lawsuit over cost-sharing reduction payments

“It cannot be overemphasized that, as changes and reforms to the individual market are considered as part of a broader package, the timeline is extremely short to advance these crucial steps to improve stability and affordability for consumers in the individual market and have a positive impact on 2018 premiums,” Tavenner wrote.

AHIP’s letter is in line with what other payer groups have said publicly about the Republican healthcare bill. The National Association of Insurance Commissioners submitted a letter (PDF) late last week to Senate leadership with a similar message, saying “guaranteed payments for the CSR program and market stabilization funds will help increase consumer options and make coverage more affordable.”

AHIP’s letter also includes calls for the Senate to allow states flexibility in how they choose to handle Medicaid and adds that long-term policy priorities should focus on ensuring that all Americans have access to coverage. Medicaid and the individual markets are closely tied because of the populations they serve, Tavenner wrote, as people who may lose Medicaid qualification may still not have employer insurance, forcing them to turn to the individual markets.

Medicaid is expected to be a hot-button topic as the Senate continues its work on healthcare reform, and cuts to the program are one of the chief causes for what could be large coverage losses if the bill becomes law.

RELATED: What's next for AHCA: Policy experts say even bigger battle looms for healthcare bill

Some insurance executives have commented publicly on the bill, as FierceHealthcare previously reported. J. Mario Molina, the ousted CEO of Molina Healthcare, blasted the bill and said his peers in the payer sphere are staying quiet out of fear of retribution from the Trump White House.

He hinted that his outspokenness may have cost him his job.

Paul Markovich, president and CEO of Blue Shield of California, said earlier this month that AHCA would take needed steps to help stabilize the individual markets, but added that the bill as drafted is flawed. Aetna CEO Mark Bertolini initially said that the individual markets are in a “death spiral,” but later softened his message, calling for the ACA to be fixed instead of fully repealed.

Anthem CEO Joseph Swedish also praised the House for making changes that address the current challenges in the marketplaces, and said the bill will offer more affordable choices for consumers in the short term.