Senators Plan Bipartisan Hearings On Health Care

Dave Anderson, CEO of HealthNow New York, talks with Steve Inskeep about lawmakers' plans to hold bipartisan hearings on health insurance exchanges. NPR's Scott Horsley has details and analysis.

STEVE INSKEEP, HOST:

As repeated Republican efforts to repeal the Affordable Care Act have failed, President Trump has variously called for lawmakers to try again, said that Obamacare should be left to collapse and also threatened to help it collapse by hurting insurance companies. Some Senate Republicans want to try a different path. NPR White House correspondent Scott Horsley is covering that. Hi, Scott.

SCOTT HORSLEY, BYLINE: Good to be with you, Steve.

INSKEEP: What could the different path be?

HORSLEY: Well, Senator Lamar Alexander, the chairman of the Senate committee that oversees health care, wants to tackle a relatively small piece of the insurance market - that is, the people who buy insurance for themselves. It's about 18 million people overall, and he wants to shore that up. That's the part of the market that has been most fragile. So he wants to reinforce that market, and he wants to do so on a bipartisan basis.

INSKEEP: Whoa, whoa, whoa, whoa, whoa, what's that word again - the bipartisan? OK, keep going.

HORSLEY: This would be a big departure from the GOP-only approach that's been used so far. But Alexander's working with his ranking Democrat, Patty Murray, from Washington. He says they want to include all members of their health committee, both Democrats and Republicans. In the past, Alexander's likened this to bringing the Hatfields and McCoys together. And it would certainly be a big change.

INSKEEP: OK, so what would the Hatfields and McCoys do once they're on the same page?

HORSLEY: Well, there are a variety of steps that industry people want the lawmakers to take - including some kind of reinsurance program to cover the costliest patients, more outreach to get more people to sign up for coverage. But the most urgent piece of business is to get some guarantee the federal government will keep making payments to insurance companies to help subsidize the out-of-pocket costs for low-income customers. President Trump has been threatening to cut off those so-called cost-sharing payments. And Alexander says that would, you know, really hurt customers and boost the cost of insurance by 10 to 20 percent.

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LAMAR ALEXANDER: In fact, many insurance companies have priced their rates for 2018 at two different levels - one with cost sharing and one without cost sharing. So it's important not only that the president approve temporary cost sharing for August and September, but that we, in a bipartisan way, find a way to approve it at least for one year, so we can keep premiums down.

HORSLEY: Now, the White House has been noncommittal on whether the president will continue those cost-sharing payments. White House Counselor Kellyanne Conway says a decision could be announced this week.

INSKEEP: Scott Horsley, stay with us because we're going to bring in another voice here. Dave Anderson, CEO of HealthNow New York, which is known around Buffalo and Albany as Blue Cross Blue Shield of Western New York and Blue Shield of Northeastern New York. Did I get all that correct, Mr. Anderson?

DAVE ANDERSON: Yes, you did, Steve. Thank you.

INSKEEP: OK, great. So cost sharing and this threat to withdraw cost sharing from insurance companies, what would that mean for your company or for the industry?

ANDERSON: Well, each state is a little bit different. But - so I can speak for here in New York.

INSKEEP: Sure.

ANDERSON: We were asked to submit rates with an assumption of whether cost-sharing payment reductions would be paid or not paid. The difference between those two filings for us, here in Western New York, was 18 percent.

INSKEEP: So whatever is your increase is, if you don't get the cost-sharing payment from the federal government, you're going to charge your customers about 18 percent more if you don't get it?

ANDERSON: Yes, and the complication of that is it's after the fact. So we have filed rates for 18. We expect to receive the approval levels for those rates later this month. And then we're locked and loaded for 18. So if cost-sharing reductions are not paid subsequently, we're in a Catch-22.

We don't really have the ability to go back and change those rates because they've already been approved by the state, and they're in the market. And so those - for those individuals that receive the CSR's, they would be underfunded to the amount of about 18 percent. And then, it would be on top of whatever increases would be required for the next year. So that is...

INSKEEP: Oh, because you're - premiums are going up regardless is what you're saying - this 18 percent more.

ANDERSON: It would be - if the premiums go up because of costs, which they have historically done, the 18 percent would be on top of that.

INSKEEP: So the president made another statement on Twitter the other day. He said if Obamacare is hurting people - and in his opinion, he says it is hurting people - why not hurt insurance companies? What did you think about when you heard the president suggest it would be good to hurt insurance companies?

ANDERSON: Well, certainly when they - insurance companies versus our members are one in the same. And unfortunately, under the CSR situation, those individuals who would receive the highest increases are those that can least afford it. So to hurt the insurance companies, it really means that it reaches through and hurts those that can least afford it.

INSKEEP: And let's just remind people, when you say CSR, that's cost-sharing reductions, right?

ANDERSON: Reductions, correct, yeah.

INSKEEP: So that's actually the government subsidizing you so that you can give a lower premium to people. So in this situation, where lawmakers are also talking about fixing the individual insurance market in some way, what is one thing that you want from the federal government?

ANDERSON: Well, what we really need is stability in the marketplace. What has happened is we are attempting to manage costs and premiums in a - against a moving target. And it's very difficult when you have to set your premiums well in advance for the next year. And year over year, you have great amount of instability in the marketplace.

You can't have a predictable premium situation for the members that you're trying to serve. People cannot live in a situation where their insurance premiums will fluctuate dramatically year over year. We're just seeking a certain amount of stability.

INSKEEP: You want stability more than any particular rule?

ANDERSON: I think the rules lend toward stability. But, yes, we - rules will affect different plans different ways in different states around the country. What we need is a set of rules that are stable, and then we can manage around that.

INSKEEP: Dave Anderson, thanks very much, really appreciate it.

ANDERSON: Yes, thanks for having me.

INSKEEP: He is CEO of HealthNow New York. And NPR's Scott Horsley is still with us. Scott, what did you hear there?

HORSLEY: Well, you heard Dave Anderson say what they're looking for is stability. And that's precisely what this market is missing right now. It's a very uncertain time for the insurance industry and, therefore, for their customers. The industry has been lobbying the White House. They've been lobbying regulators at HHS.

And they're lobbying members of Congress, according to the Center for Responsive Politics, which tracks this sort of thing. The industry spent $78 million in campaign contributions so far this year. And the single biggest chunk of that has come from Blue Cross Blue Shield.

INSKEEP: Scott, thanks very much, really appreciate it.

HORSLEY: Good to be with you, Steve.

INSKEEP: That's NPR's Scott Horsley.

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