Health insurers, working to finalize bids by a June deadline to
participate in 2020 as qualified health plans in Affordable Care Act exchanges,
are once again facing uncertainty arising from an action taken by the Trump
administration. A March 25 filing from the Dept. of Justice asked the Fifth
Circuit Court of Appeals to strike down the entire ACA, not just the individual
mandate.
As a practical matter, credit rating agency A.M. Best asserts in
a March 27 briefing paper that as the industry prepares for the 2020 selling
season and rate filings, “the prospects of uncertainty will be disruptive” as
the Trump administration’s move ramps up pressure on health insurers. But other
experts see the latest maneuvering on Capitol Hill as unlikely to shift plans
off course in the short term.
If the ACA were struck down by the courts, the effect of that
would be “breathtaking,” Timothy Jost, emeritus professor at Washington and Lee
University School of Law says. “It would mean 20 million people would be off
health care,” end Medicaid expansion and consumer protections for people with
pre-existing conditions, jeopardize the framework under which the FDA approves
biosimilar drugs, and much more. “It would be a disaster for the health care
system and every part of it,” he says.
In A.M. Best’s analysis, the firm worries that “if Medicaid
expansion and/or the individual exchange programs are eliminated or changed
substantially, the health insurance industry could face a loss of premium,
excessive administrative overhead and financial losses.”
“States may not be able to absorb the full cost of providing
Medicaid coverage and may change the eligibility definition to reduce
enrollment. If provisions such as essential health benefits, free preventive
care, limits on out-of-pocket maximums and coverage for dependents up to age 26
are no longer required, commercial groups may choose to offer a lower level of
benefits, thereby reducing premium levels.”
From
Health Plan Weekly
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