Obamacare Replace Outline

Updates From Your Indiana Health Insurance Company

On February 16th House Republicans release a 16-page power point on replacing the Obamacare.

The first couple pages are examples of how the ACA has failed to deliver it’s intended goals. The examples give a snap shot of a loss of network access, increasing premiums and increasing out of pocket expensive. These examples are accurate and true.

The power point quoted the CEO of Aetna on the death spiral that is occurring in the individual market. Also mentioned is Humana’s exit from the individual market. Both of these statements are true.

Page 6 shows the premium increase in 2017 for all the states. One thing to note for Indiana, the Department of Insurance states that the -3% was not accurate. They publicly state that Indiana’s increase was closer to 30%. Which beg the question on what methodology did the government use to determine the individual rate increase.

The next slide touches on the lack of health insurance choices. The slide states that in 2016, there were 225 counties with only one individual health insurance choice. In 2017, that increased to 1,022 counties with only one choice. For Indiana, this has also been an issue. Anthem is the only carrier offering coverage in all of Indiana’s counties. Some rural Indiana counties have been deeply impacted, but the lack of competition and lack of network access.

On page 8 we start to see the outline of what House Republicans want to deliver. These are bullet points or talking points with little information on implementation.

The next slide outlines removing Obamacare taxes and the elimination of the Individual & employer mandate. It also states the removal of Medicaid expansion, which might be the biggest insurer of the ACA. Just in Indiana, HIP 2.0 now insures over 400K members under the ACA.   Also mentioned is open-ended subsidies, which is a very interesting concept.

The GOP stresses protecting patients with pre-existing conditions and allowing for adults to stay on their parents policy until age 26. The GOP is also addressing the traditional Medicaid and the need to modernize it. There is some info on allowing Medicaid expansion enrollees to keep that coverage for a period of time.

There is a push to transfer healthcare reform back to the state level. Each state, would be responsible or required to repair the damage that Obamacare has created. There seem to be an emphasis on going back to high risk pools. Indiana had one of the more successful high risk pools compared to other states. That risk pool was subsidized by the health insurance industry. At the time, those premiums were considered unaffordable for most. Now those premiums are below current individual markets.

There is a big emphasis on the Health Savings Accounts for individual and family plans. They want to open up the H.S.A contribution levels to the out of pocket maximum and give a wider range of medical services that the money can be used for on a tax deferred basis.

Tax credits for All!

This is very interesting and we hope there is more information released. Instead of tax credits being based on income, they would be based on age. Older members would receive a higher tax credit to offset the increased cost. There is even mention, that if you don’t use the tax credit, you can place it into to your H.S.A custodial account. This would have a huge impact.

As we come to the end of the power point, we see the buying insurance across state lines. This option would create major obstacles and could really destabilize the individual market. Each state has their own set up which mandates what individual health plans must cover. For example, Indiana has an autism mandate, while Illinois has a fertility mandate. If you are an Indiana resident that needs fertility coverage or vice versa, you would purchase a plan with that that coverage. This would cause the insurance companies to set up shop in the state with the lowest amount of mandates. The other issue is contracted reimbursement rates. A policy in Indiana, may only pay up to a certain amount for a procedure. That procedure in another state could be much higher and thus the member would be billed the difference.

All in all, this power point is the first step towards what the GOP wants to deliver for the replacement of the ACA. I think it’s obvious, there is a lack of insight from experts active in the individual markets. That is not to say that on a state level, we could develop healthcare reform that gives all parties what they need.

Anthony Nefouse
Indiana Health Insurance Company

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