It's unclear whether UnitedHealth's concerns about the Affordable Care Act exchanges will cause it and other insurers to abandon the market altogether. But should that come to pass, how the government will react may largely depend upon who is in power, according to Merrill Matthews, resident scholar with the Institute for Policy Innovation.
The nation's largest insurer said late last month that it cannot sustain the financial losses it is experiencing on the exchanges, and therefore will consider leaving the ACA individual market after 2016. Other major insurers have also experienced individual market challenges, though after UnitedHealth's announcement many expressed confidence in the ACA exchanges.
But in the event that a significant number of insurers do exit the exchanges, it's unlikely a Republican Congress or White House would do much to stop it given the party's general opposition to the ACA, Matthews writes in a piece for Forbes. If Democrats are in charge, he argues, the government probably would try to prevent such an exit from happening.
One option that a Democratic government might employ would be to restore funding for the risk corridor program, according to Matthews. A significant shortfall in risk corridor payments for 2014 has hit smaller insurers hard, including several ACA-created consumer operated and oriented plans that were forced to close. The Centers for Medicare & Medicaid Services recently said in a memo that it is committed to paying insurers what they are owed, which may require the agency to appeal to Congress for more appropriations.
Or, Matthews writes, the government could require insurers to operate on the exchanges if they want to also provide either Medicare or Medicaid coverage. Similarly, states could mandate that if health insurers want to sell insurance products in other markets, such as long-term care coverage, they must also offer products in the ACA exchanges.
To learn more:
- read the Forbes piece
Risk corridor program shortfall hurts more than just CO-OPs
CMS will seek ways to make up for risk corridor shortfall
Losses lead UnitedHealth to rethink role in ACA exchanges
Q3: Big five insurers post positive results, but struggle on exchanges
Despite UnitedHealth's exchange struggles, other insurers still optimistic