President Donald Trump met with major health insurers Monday morning, in the midst of intensifying public pressure to preserve the law and political divisions over how to best dismantle and replace former President Barack Obama’s signature domestic policy achievement, the Affordable Care Act.
The meeting included leaders from Blue Cross Blue Shield, Cigna, Humana, UnitedHealth Group, Aetna, Anthem, Kaiser Permanente and the industry lobbying group, America’s Health Insurance Plans.
“We must work together to save Americans from Obamacare,” Trump said in his public remarks before the meeting began. He criticized the Affordable Care Act for creating minimal health coverage requirements that restricted the types of plan insurers could sell. He said that a replacement would allow insurers to sell plans across state lines.
“Obamacare forced providers to limit the plan options they offered to patients and caused them to drive prices way up,” Trump said. “Now a third of U.S. counties are down to one insurer, and the insurers are fleeing. You people know that better than anybody.”
Trump also called for expanded health savings accounts, tax-exempt financial accounts used to pay for medical expenses.
In remarks to the National Governors Association before the meeting with insurers, Trump said that the plan to repeal and replace the Affordable Care Act would give states the flexibility they need to make health care work. He also said the politically wise thing for Republicans would be to let the law “implode” so that its failure can be blamed on the Democrats.
“Let it be a disaster, because we can blame that on the Dems that are in our room — and we can blame that on the Democrats and President Obama,” Trump said. “But we have to do what’s right, because Obamacare is a failed disaster.”
Trump called insurers to the White House at a time that the short-term future of the Affordable Care Act’s exchanges, where people buy individual health coverage, are in a precarious position. That means the industry comes to the meeting in a position of some power; although Republican lawmakers have vowed to replace the law, the prospect of millions of people becoming uninsured in the interim has become a major worry.
Over the past month, more insurers have warned that they are pulling out next year or considering it — and Aetna chief executive Mark Bertolini has described the exchanges as being in a “death spiral.”
Humana — which insures about 150,000 people on the exchanges this year — announced in mid-February it would exit the exchanges in 2018. In an earnings call, Molina Healthcare disclosed that its exchange business lost $110 million in 2016 and said it would evaluate its participation for next year on a state-by-state basis. A Molina spokeswoman said the company, which insures 1 million members through the exchanges, was not invited to the meeting.
Before the closed-door portion of the meeting began, Joe Swedish, the chief executive of Anthem, praised proposed actions the administration announced earlier this month to stabilize the Affordable Care Act exchanges — a business in which he said his company was “deeply embedded.”
He was referring to a proposed rule that would tighten up the qualification for “special enrollment periods,” which allow people to sign up for insurance after the enrollment period is over. Insurers have said that people are misusing those periods, waiting to sign up for health coverage only when they’re sick.
“I don’t want to miss the opportunity to thank you for the swift and decisive actions that occurred most recently,” Swedish said.
“It was going to be an implosion,” Trump responded. “We had to step in.”
Trump’s meeting with major insurers comes on the heels of private meetings the president has held with a handful of Republican governors, including John Kasich, Ohio, Rick Scott, Fla., and Scott Walker, Wis., and as governors from both parties have gathered in Washington for their annual winter conference.
Several governors have drafted their own proposal to repeal and replace the Affordable Care Act, which they shared Sunday with Vice President Pence and Health and Human Services Secretary Tom Price. The plan is still being finalized and has not yet been unveiled, but it aims to preserve more of the law than is currently envisioned by some congressional Republicans while also providing states with additional flexibility.
Sen. Rob Portman, R-Ohio, who spoke with Michigan Gov. Rick Snyder, R, last week, said Snyder and others seeking a middle way believe that a combination of moving more Medicaid recipients into managed care plans and having them take personal responsibility for their care with modest fees could cut costs. But such a move, Portman emphasized, should be combined with ensuring those covered under the ACA remain insured with the help of federal subsidies.
At the same time, however, governors that did not expand Medicaid under the ACA are anxious that they are not penalized under whatever plan replaces it.
“You can’t treat an expansion state better than a non-expansion state,” said Scott, who discussed the issue with Trump over lunch on Saturday. “Because you did an expansion, you should not get more dollars.”
“He’s convinced there can significant saving there, if they have a chance to make that transition,” Portman said of Snyder.
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