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Little Consensus on Obamacare Fixes as More Plans Drop Out

By Erin Mershon, CQ Roll Call

September 26, 2016 -- At the top of Anthem Inc.'s wish list, when it comes to potential changes aimed at shoring up the struggling health marketplaces, is improving the risk adjustment formula. And tightening special enrollment periods. And extending the moratorium on the so-called health insurer fee.

Elizabeth Hall, the insurer's vice president for federal affairs, struggled to choose just one top priority at a Monday congressional briefing by the Alliance for Health Reform. The forum was centered on the ongoing issues with affordability, competition, and choice on the individual market exchanges established by the health law.

The law has been besieged by a series of negative reports this fall. Major insurance companies like UnitedHealth Group Inc. and Aetna Inc. announced mass exits from many of the marketplaces in which they were participating, citing sizable financial losses. Those that remain are requesting double digit premium increases to make up their own shortfalls.

On Monday, Blue Cross and Blue Shield of Tennessee—the largest insurer in the state's individual market by far—announced that it would not offer plans next year in major cities like Nashville and Memphis. On Friday, Blue Cross and Blue Shield of Nebraska announced it wouldn't participate in the state at all in 2017. Both blamed the withdrawals on millions in losses.

"We're very much in a transition period," Hall said. "It's been a longer transition period than I think the law had laid out and than we all had expected."

Political operatives, academics, lobbyists, and others have offered a broad spectrum of policy proposals aimed at strengthening the marketplaces, ranging from controversial, partisan policies like a public insurance option or a full repeal to smaller, granular tweaks that some say will have better prospects in a divided government. But nearly all experts remain divided on which are feasible or which to prioritize.

At Monday's briefing, Hall joined Peter Lee, the executive director for Covered California; Chris Holt, director of health care policy for the American Action Forum; and Sabrina Corlette, senior research development at Georgetown University's Health Policy Institute.

The only potential "fix" that earned significant praise from a majority of the panel concerned risk adjustment, one of the so-called premium stabilization programs included in the health law. Hall, Lee and Corlette all praised the regulatory fixes the administration proposed in a recent rulemaking process.

Otherwise, the panelists proposed a grab bag of policies—and often disagreed with one another. Corlette took aim at Hall's insistence on tightening special enrollment periods. She noted that there was little to suggest that people signing up during the periods needed more care than others and argued that, to the contrary, they might improve the risk pools. Corlette and Lee also suggested that investing more in outreach and marketing would help attract the young, healthy people needed to improve the risk pools and keep premiums low.

Holt, meanwhile, emphasized a conservative idea to loosen the so-called age rating bands that restrict how much health insurers can charge individuals of different ages. He said that some Democratic health economists and Democratic hill aides, had expressed some support for the ide in private conversations. However, Democratic lawmakers blasted the idea almost universally in a June Energy and Commerce Committee hearing that touched on the issue.

None of the panelists thought that one potential fix—combining the individual markets that exist both on and off the exchanges—would have any impact on the exchanges, since the risk between the two is already pooled.

Reaction to Blue Cross Plans' Announcements

Some of the changes under discussion could convince insurers who have left the marketplaces to return. Blue Cross Blue Shield (BCBS) of Nebraska officials said Friday that the company would continue to work with officials to consider returning to the exchange next year. And BCBS of Tennessee said it was monitoring to consider a possible return "if conditions permit."

Still, the withdrawals drew quick political ire. Sen. Lamar Alexander, R-Tenn., who helms the Health, Education, Labor and Pensions Committee, blasted the 2010 law following the Tennessee announcement and called again to repeal the law.

"This is more evidence that Obamacare is falling apart," he said in a statement. "Short term, we need to give families the opportunity to use their Obamacare subsidies to buy a policy for 2017 outside of the exchange."

Nebraska Sen. Ben Sasse had a similar reaction Friday. "Enough is enough," he said.

The Tennessee insurer called the decision "difficult but necessary" in a statement.

"Beyond closing the gap between rates and medical costs, we continue to have concerns about uncertainties with the ACA at the federal level that could lead to future losses," the company said in a statement. "As a result, we've made this decision to scale back in an effort to limit the risk of losses and protect the financial security our more than 3 million members rely on."

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