Payer, provider leaders add patient perspective to Affordable Care Act market stabilization talks

The Senate HELP committee turned its attention to health industry leaders yesterday. A surgeon, the CEO of a health system and a health insurance executive were among the witnesses at the last of four hearings on ways to stabilize the ACA’s individual marketplaces.

Previous hearings at the Health, Education, Labor and Pensions committee included testimony from state insurance executives and governors from both sides of the aisle.

The committee plans to craft a bipartisan bill to stabilize the insurance markets as early as next week. Time is getting short for insurance companies, which are waiting to see what happens in Congress before they set their individual market rates for 2018. Companies have until Sept. 27 to sign final contracts to participate in the exchanges next year.

And although the witnesses voiced their support for ideas that came up at the first three hearings—such as reinsurance and catastrophic coverage and cost-sharing reduction payment guarantees—they also brought to the table a unique focus on the patients they serve and providing them with high-quality, affordable care.

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“I personally believe that repeal and replace was our best option to find a more patient-centered system that offers greater access and patient choice at affordable rates,” said Manny Sethi, M.D., president of Healthy Tennessee, a wellness-focused nonprofit.

“But now, we find ourselves in a moment where the individual market in Tennessee is in critical condition and on the verge of collapse. We must rapidly take action, and I view the potential solutions through the lens of [an orthopedic] trauma surgeon. We must first stop the bleeding, then work on getting healthcare healthy again.”

The high cost of healthcare services and insurance premiums hit hard-working people, some self-employed, who find themselves making a choice between heating their houses and getting healthcare coverage, said Susan L. Turney, M.D., the CEO of Marshfield (Wisconsin) Clinic Health System, which includes a multispecialty physician-based practice, hospitals and a health insurance arm.

Making health insurance coverage affordable is a “critical piece,” agreed Robert Ruiz-Moss, vice president of the individual market segment at Anthem, adding that the insurer “remains committed to transforming healthcare by making it more affordable, higher quality and more accessible for all.”

The difference between the cost of premiums and any tax penalty a patient might pay for not having coverage is so wide, people self-opt out, he added.

And inexpensive copper plans, which have low premiums and high deductibles or co-pays and have been raised during the hearings as one solution, are now available only to people under age 30. If Congress opens that up to a wider segment of the market, Ruiz-Moss said, costs for those plans will go up. 

The witnesses and committee members spent time talking about essential health benefits from the point of view of patients, too.
 

Christina Postolowski, Rocky Mountain Regional Director of Young Invincibles, a nonprofit research and advocacy organization for young adults, noted that young, healthy consumers (a member segment that can drive costs down when they join markets) have three care priorities: maternity, preventative and mental health and substance abuse. 

If those benefits aren’t required under the ACA, they might not participate in the insurance markets, she said.

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