President Donald Trump and other Republican leaders have been working to repeal and replace the Affordable Care Act. And the millions of Americans who have health insurance through the Obamacare marketplaces aren’t the only ones wondering about their fate. Leaders of insurance companies are, too.
Sabrina Corlette, a research professor the Center on Health Insurance Reforms at Georgetown University and colleagues interviewed executives at 13 different insurers to get their perspectives in this moment of uncertainty. Their report was published by the Robert Wood Johnson Foundation and The Urban Institute.
All Things Considered‘s Audie Cornish talked with Corlette Friday about the findings. The conversation has been edited for length and clarity.
On what worries insurers most about repeal and replace
The big issue across every insurance executive’s mind is the uncertainty. Particularly concerning is the potential that two legs of the ACA’s three-legged stool might get knocked out. You have number one, subsidies that help people afford insurance premiums; and, number two, a mandate that helps get healthy people to enroll in health care. Congress has threatened to repeal both of those things. And if that happens, insurers are going to need to leave the market, because they won’t be able to make a go of it.
On how uncertainty affects insurance plans
First thing to know about insurers in the Obamacare marketplace is that they’re not monolithic. We talk to large national carriers, for-profits, nonprofits, local community-based provider plans, all really coming at this from different perspectives. Some are very committed to staying in the market and serving populations, others not so sure. But across the board they all said we cannot tolerate uncertainty.
There comes a certain point where they can’t price the product high enough to account for the uncertain environment they’re in. And they have to make those decisions right now because they’re putting together their  products for review process starting in May. My guess is, when they come out in May we’ll see some pretty big price hikes because the uncertainty they feel in the policy world from Congress and the White House will play out into the premiums that people will ultimately pay.
On what provisions of Obamacare need to remain
One thing we heard over and over was the need to maintain some form of incentive for healthy people to sign up for coverage. The Obamacare approach has had a penalty for people who don’t enroll, which has been very controversial in Congress. But insurance companies will tell you they don’t think it was a strong enough incentive. They feel like it needs to stay or replaced with something at least as strong to get people to sign up.
On if insurers will fight to keep healthy people in the system
Whether or not they’ll fight for a specific mandate, I’m not sure. But they’ll fight for the balance of healthy and sick. If [that’s not there], if it’s a market that just allows sick people to come in without healthy people, it’s not a workable market. Another thing they could do is say, ‘If you’re getting rid of the original mandate you have to allow us to go back to the days when we can deny people insurance if they have a health issue.’ Because you can’t have it both ways.
On whether insurance companies want to revert to pre-ACA times
No, not at all. Before the Affordable Care Act, insurance companies were in many ways the bad guys. People didn’t like them because they denied coverage to sick people and charged more. Now I think their public image has improved. Everyone gets covered, even with preexisting conditions. I don’t think they want to go back to the days when they were the bad guys.
On the other hand, I don’t think they feel that Obamacare was a perfect law. They found plenty to criticize. But my sense is that they’d rather see improvements to basic structure rather than starting back from scratch.