As Republicans struggle to unify around a plan to replace the Affordable Care Act, insurance executives appear to have found a friendly ear for their demands

If you want to know where Republicans find ideas to reform Obamacare, look no further than the private insurance companies.

As Republicans struggle to unify around a plan to replace the Affordable Care Act, and at the same time attempt to keep insurance companies in state marketplaces, health insurance executives appear to have found a friendly ear for their demands for change.

The most striking inclusion of industry ideas in policy appeared this week, when the Department of Health and Human Services (HHS) issued a draft rule that could dramatically affect individuals who buy insurance on state marketplaces.

Proposed changes would shorten the window to enroll in coverage from three months to six weeks, increase out-of-pocket costs to consumers and give regulatory authority for health plans to states – all proposals that insurance companies have called for since Donald Trump’s inauguration.

What an Obamacare replacement could look like under Tom Price Read more

The public has just 20 days to comment on the draft rule change – rather than the usual 30. That is despite HHS officials’ findings that the proposed changes “could reduce the value of coverage for consumers, which could lead to more consumers facing increases in out-of-pocket expenses, thus increasing their exposure to financial risks associated with high medical costs”.

Benefits to consumers, the rule argued, would come through stabilized premiums and would prompt insurance companies to remain in the market despite the current uncertainty surrounding Republicans’ plans for the system.

“I don’t believe that for a minute,” said Linda Blumberg, an insurance policy expert at the Urban Institute, of the supposed benefits to consumers. “The ways it can hurt consumers are multiple.”

Blumberg and other experts have argued the rule does little to stabilize the insurance market, which she and others said could best be done by recruiting more healthy people to join.

“These are very much directed toward segmenting the risk pool, segmenting the cost of the healthy from the cost of the sick,” said Blumberg. “This has always been the way insurers most profit. They will make much more money doing that than they will by managing the medical care of a broad diverse population.”

The new rule comes amid Republican disagreement over how to move forward with repealing the Affordable Care Act, a seven-year campaign promise from conservatives. Many Republican plans to replace the ACA exist, but none have found a way to stitch together the conservative and moderate members of the party.

This is not a rule that puts consumers first – this is just giving insurers a wishlist of what they want Lydia Mitts, Families USA

On Thursday, House Republican leaders discussed broad outlines for a replacement for Barack Obama’s signature health policy, which led to 20 million people gaining health coverage. The House speaker, Paul Ryan, said that after Congress’s forthcoming weeklong recess, “we intend to introduce legislation to repeal and replace Obamacare”, without giving further details.

Republicans Rand Paul and Mark Sanford have proposed legislation that would completely repeal the Affordable Care Act and expand savings accounts that come with tax benefits intended for emergency use. But it is unclear which of their ideas might end up in an eventual GOP bill.



Trump himself claimed at an eccentric press conference on Thursday: “We’re doing Obamacare. We’re in final stages. We should be submitting the initial plan in March, early March, I would say.”

Without a unifying plan from Republicans looking to avoid political blame for sowing chaos, the insurance industry has offered ideas to stabilize the markets under threat of pulling out altogether.



Facebook Twitter Pinterest Donald Trump said at a press conference in Washington that his administration was in the ‘final stages’ of its new healthcare plan. Photograph: REX/Shutterstock

“Their advertised objective here is to stabilize the market,” said Marc Goldwein, vice-president of policy at the Committee for a Responsible Federal Budget. “One way to keep insurance companies selling insurance is to give them some of the things they’re asking for.

“Whether those are things that hurt the consumer, or benefit the consumer, or are neutral to the consumer, will depend,” said Goldwein.

The proposed rule was released just nine days after executives of Blue Cross Blue Shield met administration officials, when a list of “actions” needed to “stabilize the private health insurance market” was distributed. Many of those same actions appeared in a Blue Cross Blue Shield policy document from 30 January, titled “Moving forward: a health insurance market for 2017 and beyond”.

The proposed rule, if approved by the department now headed by the vehement Obamacare critic Tom Price, would have a tangible impact on when individuals can buy health insurance, and what they get when they do.

“The biggest issue, and what’s most important for people to know, is this rule does nothing to help people get coverage or afford care,” said Lydia Mitts, associate director at Families USA, a left-leaning patient advocacy group. “This is not a rule that puts consumers first – this is just giving insurers a wishlist of what they want, making it harder for people to get the coverage they need.”

First, the period to sign up for health insurance would shorten. Last year, 11.3 million people signed up for health insurance through exchanges between 1 November and 1 January. The proposed rule would shorten that period to six weeks, from 1 November to 15 December.

Burst your bubble: five conservative articles to explain who Trump has left Read more

Next, insurers could require more verification paperwork from consumers looking to take part in so-called “special enrollment periods”. These are special opportunities to sign up for healthcare offered to people who may have lost a job or become pregnant.

Third, if a customer’s insurance policy were canceled because the customer did not pay, insurance companies could require full repayment before allowing customers to sign up for a new plan. This proposal, the rule argues, would encourage people to “maintain continuous coverage”.

Because the ACA required insurers to offer a set of benefits, the new rule would also allow insurance companies to offer less valuable plans, meaning that out-of-pocket costs would increase, and subsidies could go down. The rule would also lower requirements for the number of some types of doctors insurers are required to have in plans.

“I’m not privy to what is going on in the administration, but these are things that I think are coming from the insurance industry more than they are from policymakers,” said Blumberg.

“There seems to be a lot of consistency between the big insurers and the policies that are being promoted by critics of the ACA.”