| NEW YORK
NEW YORK May 4 U.S. Republicans may be moving
ahead with a vote to repeal Obamacare, but the uncertainty about
what a national health law may look like is clouding insurers'
decisions on whether to stay in the individual insurance market
Republicans do plan to vote on the U.S. House of
Representatives bill, the American HealthCare Act, this
afternoon, a wide-reaching piece of legislation that would undo
the central tenets of Obamacare and create a pathway for an
orderly transition next year to the new law.
The House, however, is not the final word. The bill must
next go to the U.S. Senate, where the Republican majority is
smaller and some have spoken out against the bill. Any changes
there would then need to go back to the House for a sign-off, a
process with an uncertain timing.
Insurers do not have the luxury to wait and see what the
final outcome is before they move ahead with decisions about
next year. State regulatory deadlines this week to submit 2018
insurance plans have forced some insurers to make a call on
whether to participate in the individual insurance market next
year despite not having details they say they need.
"The vote today does not relieve the uncertainty and
concerns that the insurance industry has about the
(individual)market for next year and beyond," AEI health policy
expert Joseph Antos said.
The insurers have been loudly complaining about the
Republican back-and-forth. Republicans pulled the first version
of their bill earlier this year, and have issued conflicting
statements about whether the administration will continue to
fund cost sharing subsidies this year or next year, which amount
to $7 billion this year.
In the last week, they have used public conference calls
with Wall Street, letters to Congressional leaders and press
statements, to promise that if Republicans do not quell the
uncertainty over next year, they will leave Obamacare or raise
rates beyond what consumers want to pay.
"The window is quickly closely for action to be taken on
(subsidies) in 2018," Kristine Grow, a spokeswoman for the
industry's biggest lobby, America's Health Insurance Plans,
Aetna Inc, which cut its exchange presence by
three-quarters this year, on Wednesday said it would exit the
Virginia Obamacare market next year.
Virginia and Maryland both had regulatory deadlines this
week. Others, like Maine and Pennsylvania, moved those deadlines
back to later this month or have July deadlines to give insurers
more time to decide. The federal government deadline is in June.
"I think the decision making that we have to make right now
has to be based on the reality as it is today," Aetna Chief
Financial Officer Shawn Guertin said in an interview on Tuesday
after reporting it would lose $200 million on the business this
year and one day before the company announced it would pull out
of the Virginia market for 2018.
Molina HealthCare Corp and Anthem Inc have
also said in the past week that they need to have resolution on
issues like the government subsidies and the individual mandate
settled. Together they help build a balanced pool of healthy and
sick people that enables insurers to keep prices down.
When only half the number of people signed up compared to
expectations, and prices pushing the young and healthy to forego
insurances, the market has already been a loss maker for many
Insurers who are choosing to stay in the market are dealing
with uncertainty about the subsidy payments - estimated to be
about a 20 percent hit to premiums next year - by raising rates
or submitting two sets of rates to states that allow them, like
But there are bigger issues that could decrease competition
and leave Americans in some areas with no insurer next year - a
version of "the death spiral" President Donald Trump tweeted
about on Thursday.
"Are the exchanges going to be there in 5 years and if yes,
what will they look like?" said Dan Mendelson, head of
healthcare consultancy Avalere Health. "The program needs some
level of competition to operate effectively."
(Additional reporting by Yasmeen Abutaleb in Washington D.C.;
Editing by Nick Zieminski)