Published in Health Care
Dominick Pallone, executive director of the Michigan Association of Health Plans Dominick Pallone, executive director of the Michigan Association of Health Plans

REPORTER’S NOTEBOOK: Practicality, not politics, needed to fix ACA

BY Sunday, September 17, 2017 12:31pm

Dominick Pallone considers it a hopeful sign that the debate over health care in America seems to be moving beyond political rhetoric and ideology.

Weeks after Senate Republicans failed in their quest to repeal and replace the Affordable Care Act, a bipartisan group of governors offered a proposal to alter the federal law and stabilize the individual health insurance market. And earlier this month, a Senate panel convened hearings about a bipartisan approach to fix the law.

Pallone, the executive director of the Michigan Association of Health Plans, said that approach is exactly what’s needed right now and represents “an attempt to be practical, which is always welcome in politics at any level.”

“It seems to be some discussion to move the conversation forward,” Pallone told me in a recent conversation about the proposal from the governors, led by Gov. John Kasich, R-Ohio, and John Hickenlooper, D-Colorado.

“I like that it’s led by governors and that they’re putting their opinions down on paper, rather than just trying to cut deals behind closed doors. And I like a lot of the content that’s in there,” he said. “It’s a bipartisan call for stabilization. It shows that the individual market across the nation is in trouble, and that we need to take actions both at the federal level and state level to help stabilize the market.”

Right now, stabilization and practicality are clearly in need to change the ACA and stem the soaring costs of individual health coverage.

In Michigan, the state Department of Insurance and Financial Services says that premiums for the nearly 300,000 state residents who buy their own health coverage on the public health exchange will increase an average of 27.6 percent for 2018. That average is based on the federal government not providing subsidies for individual policies for people who meet the criteria.

Rate requests to state regulators for individual policies in 2018 range from 16.5 percent proposed by Alliance Health and Life Insurance Co. to 59.4 percent for Meridian Health Plan of Michigan Inc.

Grand Rapids-based Priority Health proposed a 19-percent increase, according to a state summary of 2018 rate proposals for individual policies. Blue Cross Blue Shield of Michigan proposed a 31.7-percent increase and its HMO subsidiary, Blue Care Network, seeks an increase of 22.6 percent.

The ACA proposal from the group of governors parallels much of what the MAHP would like to see occur to stabilize the individual market, Pallone said. They include:

  • Congress committing to maintain subsidies for individual policies at least through 2019
  • allowing waivers for states from the 10 essential health benefits the law requires insurers to include in a policy so carriers can “pursue innovative strategies to strengthen health insurance markets while retaining the basic protections of the ACA”
  • Considering the formation of high-risk pools for people who cost the most to insure
  • Looking at reinsurance to cover claims that exceed a certain amount
  • Encouraging greater use of value-based care models
  • Maintaining the mandate requiring everybody to buy health coverage, either through employers or on their own.

The latter point would help “to prevent a rapid exit of additional carriers from the marketplace” until Congress “can devise a credible replacement,” the governors wrote in an Aug. 30 letter to congressional leaders.

Beyond stability, insurers that sell individual policies on the public exchange also could use flexibility in how they fashion benefits packages to make coverage more affordable, Pallone said.

Whether the bipartisan proposal from the governors goes anywhere, no one knows. Yet Pallone, whose association represents 13 health plans that cover 2.5 million lives in Michigan, says he’s optimistic that it can ultimately lead to action that makes the ACA better. He adds, however, that he has little choice but to think optimistically.

“It’s politics. It always politics. Practicality doesn’t always rule the day, and reason and rationale doesn’t always rule, but I have to be optimistic. And that’s why I do like that these governors put this out so we can have the discussion and so folks in Congress can debate this,” he said.

Read 3240 times Last modified on Monday, 18 September 2017 11:02