CINCINNATI - A bipartisan group of governors hope to end the years-long political standoff over the nation’s health law with key changes they say will better control costs, shore-up the individual insurance market and give states more control over health plans sold in their borders.
The proposal, headed by Ohio Republican Gov. John Kasich and Colorado’s Democratic Gov. John Hickenlooper, lands as final decisions are made by insurers about whether to sell plans in the individual markets created through the Affordable Care Act, commonly dubbed Obamacare.
The individual marketplaces, known as exchanges, are where families and individuals who don’t have employer-provided health plans, Medicare or Medicaid can shop online for insurance. While most Americans are insured through plans with their employer, about 22 million people now have coverage through the individual markets.
Large insurers including Anthem Blue Cross Blue Shield have begun pulling out of the individual markets in several states, citing uncertainly about Obamacare’s future given the political turmoil over the law and growing losses on the health plans they sell.
In June, Anthem announced it would pull out of Ohio’s individual market – a move that leaves 18 counties with no individual insurance provider. An estimated 10,500 people could be without an option as a result, according to Ohio’s Department of Insurance.
Many of the proposals included in the bipartisan governor’s plan are centered on fixing the individual market's woes. One key item is a guarantee of cost-sharing reduction payments, known as CSRs, to insurers selling individual market plans.
“Continuing uncertainty about the direction of federal policy is driving up premiums, eliminating competition and leaving consumers with fewer choices,” the governors wrote in a letter to Congress outlining their plan. “Congress and the Administration need to send a strong signal now that the individual market will remain viable this year, next year and into the future.”
The proposal also recommends:
• Creating a temporary stability fund that can help insurers limit their losses for covering the sickest, high-cost patients.
• Providing tax breaks for insurers that enter markets where only one insurer is participating, or allowing individuals in those counties to buy federal employee insurance plans.
• Allowing states to apply for a waiver that would allow them eliminate certain provision of the ACA, including the individual and employer mandate, certain essential health benefits and the online individual marketplaces.
• Forbidding states to waive any provisions that deal with coverage for preventative care, coverage for adults as dependents through age 26, or preexisting condition exclusions.
What’s next?
Next week, a host of Senate hearings are scheduled to tackle the mounting troubles facing the individual insurance market. Hickenlooper and Kasich are both slated to testify.
Insurers have until the end of September to make their final decisions about whether to sell plans on the individual markets. It's estimated that roughly 2.5 million Americans in about 1,400 counties will have only one insurer from which to buy a plan.
