The Senate vote on a bill to repeal and replace the Affordable Care Act is, according to conventional wisdom, one week away.
And we still don’t know what’s in the bill.
Not having concrete information is deeply uncomfortable for a journalist like me.
But for lots of people, like those who work in the insurance industry, not knowing what’s in that bill is a bigger deal. Wednesday is a deadline of sorts for these companies. If they want to sell policies next year in states that use the federal health exchange on Healthcare.gov, they have to let Health and Human Services know their intentions.
How are they dealing?
I reached out to a couple of insurance executives and asked.
Wednesday morning, Oscar announced it’s going to keep selling individual insurance in New York in 2018, and expanding its offerings in five states – New Jersey, Ohio, California, Florida and Tennessee.
It’s a bold move, considering Congress is right now considering dismantling the Affordable Care Act markets and changing the rules governing health insurance.
“When the dust settles, the individual market will be stable, and we want to be part of getting it there,” Schlosser told me.
He agreed with President Trump that the American Health Care Act, passed by the House in May, is “mean.”
“I think that bill was mean and I think that bill would lead to loss of coverage that would be bad for pretty much everybody in the system,” he said.
Schlosser said it’s crucial for the Trump administration to stabilize the current system in preparation for any changes. That includes enforcing the individual mandate, which penalizes people who don’t buy insurance, and promising to make cost-sharing payments required under the ACA that reimburse insurers for giving extra discounts to the lowest-income customers.
If they don’t, “it would kill the market overnight.” Schlosser said.
“That would be terrible for society, it would be terrible for the whole health care system, and everybody would be worse off,” he said.
I pointed out to Schlosser that his company has a direct line to the White House. His partner and co-founder is Joshua Kushner, the brother of Jared Kushner, Trump’s son-in-law and senior adviser.
Schlosser avoided talking about that relationship and suggested he didn’t know what Trump will do.
Later, I sat down for a cup of coffee at the National Press Club with Dan Hilferty, who runs Independence Blue Cross in Philadelphia and is chairman of the board of the Blue Cross Blue Shield Association. His company sells ACA health plans in the Philadelphia area and southern New Jersey.
“I’m here in DC because of what’s happening in health care,” he said. But acknowledged he doesn’t know what’s in the Senate bill, even though the Blue plans he represents as chairman of the association insure one-third of all Americans.
Hilferty said the ACA has problems, but it did manage to bring insurance coverage to about 20 million people who didn’t have it before. That’s what he’s focused on in meetings with members of Congress.
The Congressional Budget Office says the bill passed by the House would result in 23 million fewer people having insurance coverage in 10 years, compared to current law.
“So I would say let’s build a system that doesn’t that doesn’t push those 20 million people back to uninsured, “Hilferty said.
He says his company is focused on ensuring that whatever lawmakers do, they don’t make it harder for low-income people to get insurance.
“Frankly, we don’t care if it’s the ACA or the AHCA as long as it gives us the ability to cover more people, get them access to care and not lose money,” Hilferty said.
Like Schlosser, Hilferty is worried about what’s going to happen next year. His company has filed to sell ACA plans in the Philadelphia area. But if the Trump administration doesn’t commit to making cost-sharing payments or to enforcing the individual mandate that requires people to have insurance, his rates could go up a lot.
Either way, both companies are operating as if the ACA markets will be alive and functioning in 2018.
“I do think that in the end, reason and compassion will prevail in DC,” Schlosser said.