Health insurers, state officials: Trump undermining Obamacare

BY NOAM N. LEVEY
Tribune Washington Bureau
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WASHINGTON • Health insurers across the country are making plans to dramatically raise Obamacare premiums or exit marketplaces amid growing exasperation with the Trump administration’s erratic management, inconsistent guidance and seeming lack of understanding of basic health care issues.

At the same time, state insurance regulators — both Democrat and Republican — have increasingly concluded they cannot count on the Trump administration to help them ensure that consumers will have access to a health plan next year.

The growing frustration with the Trump administration’s management — reflected in letters to state regulators and in interviews with more than two dozen senior industry and government officials — undercuts a key White House claim that Obamacare insurance marketplaces are collapsing on their own.

Instead, according to many officials, it is the Trump administration that is driving much of the current instability by refusing to commit to steps to keep markets running, such as funding aid for low-income consumers or enforcing penalties for people who go without insurance.

“All this uncertainty is not helpful,” warned Blue Shield of California CEO Paul Markovich, who said health plans are being forced to make plans to raise premiums to account for the turmoil, jeopardizing Americans’ coverage.

Markovich was one of the few senior insurance officials who agreed to speak on the record, as many fear retribution from the White House or its allies.

But privately, many executives, including chief executives of major health plans, offered withering criticism of the Trump administration’s lack of leadership.

“It’s hard to know who’s home,” said one CEO. “We don’t know who is making decisions.”

Another chief executive said: “There seems to be no coordination or coherent planning. It’s a mess.”

A third official observed: “There is a sense that there are no hands on the wheel and they are just letting the bus careen down the road.”

Trump and GOP congressional leaders insist the marketplaces are collapsing because of flaws in the original law. They cite premium hikes in some states, and decisions by several insurers to stop selling Obamacare plans, including major national companies such as Humana and United-Health Group. That has left some areas of the country with just one health plan option next year.

“Obamacare has failed,” said Alleigh Marre, a spokeswoman for the U.S. Department of Health and Human Services. “For this reason, Republicans are reforming health care so it delivers access to quality, affordable coverage to the American people.”

Several Republican state insurance commissioners also blamed weaknesses in the law for the current instability. “There has been uncertainty with the Affordable Care Act since it started,” said Maryland Insurance Commissioner Al Redmer Jr. Maryland’s largest insurer, CareFirst, is seeking to raise rates by more than 50 percent next year.

But most health plans and state regulators interviewed for this story said the Trump administration has significantly exacerbated turmoil in the marketplaces, contributing to rising premiums and the threat of marketplaces exits.

“There is no consistency to the messages,” said Ceci Connolly, CEO of the Alliance of Community Health Plans, whose members include leading health systems such as Kaiser Permanente and Geisinger Health Plan. “We are very confused.”

The Trump administration has sent mixed signals about whether it will enforce penalties on people who don’t buy health insurance. The penalty, though unpopular, is seen as critical to inducing younger, healthier people to get coverage.

Trump and his deputies have also repeatedly threatened to withhold federal aid that helps millions of low-income Americans afford their deductibles and co-pays.

The aid, which reimburses insurers for lowering out-ofpocket costs, was paid by the Obama administration, but is now the subject of a lawsuit by congressional Republicans, who argue Congress must approve the payments.

The Trump administration hasn’t taken an official position in the lawsuit. But in recent months, the president publicly mused about stopping the payments to force Democrats to negotiate a repeal of the current law. It remains unclear whether the administration will continue the payments, known as cost-sharing reductions, or CSRs.