Thursday, December 15, 2016

The most risky thing Trump will do and it's replacing Obamacare

Please take particular note of the last paragragh!

I've been following Robert Laszewski for several years. Many of his Health Care Policy & Marketplace Review posts are also cross-posted at Forbes.
I've posted his resume below first in order to show how important his qualifications are and then excerpted two things from his two most recent posts regarding the "replace" part of "repeal & replace" which includes the transition period...a VERY risky period for Trump, Republicans, and America and everything hangs on "us" getting this right!!!
I made this as short and clear as I could--read the full articles if you want. Obamacare was a "first" and getting us out of this mess will be a "first"--it's all uncharted territory. The fines, the rising monthly premiums, the soaring deductibles, and the damage to our healthcare system (shortages of doctors, unmanageable loads of regulations and paperwork, etc.) might not seem as bad to people as a collapse of the entire system would if all this goes South!
Robert Laszewski - Health Care Policy & Marketplace Review
I am one of a kind having spent 20 years in the health insurance marketplace and 20 years inside the Beltway. I ran two health insurance businesses before coming to Washington, DC to start my own health care policy and market consulting business. Over the last 20 years my clients have been the people who run insurance companies, hospitals, and physician practices. A long time ago, I made all of the money I will ever need and I keep doing this because I want America’s health care system to work for everyone.
But will there be any insurance companies in the exchanges come 2018?
The Obamacare individual insurance market was an unsustainable place for health plans before the Republicans won the 2016 election and reiterated their promise to end it.
Most carriers are now losing their shirts on their Obamacare exchange business. Some of the biggest carriers are exiting in 2017. Others decided to hang in for at least another year hoping the new Congress and President would fix it in 2017. Now, with the Republicans promising to kill Obamacare, there is little hope Obamacare will get better for the carriers in 2017 or 2018. Most in the insurance industry believe their losses will only increase as the sick stay in the pool and fewer healthy people, having been promised something better by Republicans, hold off on paying the big premiums and having to face the big deductibles in the current plan.
The health plans are committed for 2017. But no health plan is committed for 2018.
Faced with an expected worsening bottom line going into 2018 we cannot assume the insurers won't bail. What insurance company CEO will be willing to sustain the tens of millions, or in some cases hundreds of millions, of dollars in losses they now face, and expect to continue to face, to keep the dying Obamacare program afloat as a favor to Republicans?
And remember, about half of the current Obamacare compliant market does not get a subsidy and these folks are also at risk of not finding a carrier in 2018. If the health plans get out of the health insurance exchanges they will likely either get out of the entire individual market or dramatically increase the premiums for the off-exchange market. It would appear that many of these often self-employed folks outside the exchanges voted for Republicans over their anger at Obamacare's big premiums and deductibles and could be faced with fewer or even worse individual health insurance choices in 2018.
[The following are responses to an interviewer's questions.]
What they have to do, and I don’t think they’ll do, is take the defunding bill they use to repeal Obamacare and reestablish the risk corridors and reinsurance fund. They have to do it inside the budget bill; otherwise they’ll need 60 votes.

I think what they have do is reestablish one of the parts of Obamacare that Republicans have hated the most, the so-called insurance company bailout, because if they don’t, they’re going to have a catastrophic result come 2018.

To have an orderly transition, I think Republicans need to reimplement the risk corridors by February or March. That is the only chance they have. I don’t think there is a single Republican member of Congress who has thought about this. I’m reading all these quotes and they’re completely blind to the fiasco on the individual market that they’re about to create.

The ACA’s risk adjustmentreinsurance, and risk corridors programs were intended to protect against the negative effects of adverse selection and risk selection, and also work to stabilize premiums, particularly during the initial years of ACA implementation:
Table 1: Summary of Risk and Market Stabilization Programs in the Affordable Care Act

Thoughts are welcome and please forward to anyone who can help or is interested!

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