How can insurance companies continue to insure people with pre-existing health conditions without spreading the costs through a larger pool created by a mandatory health insurance requirement?
That is one of the many questions Fred Earley, outgoing president of Highmark Blue Cross Blue Shield West Virginia, said will have to be answered if the Affordable Care Act, also known as Obamacare, is to be repealed under President-elect Donald Trump.
“It’s almost impossible to eliminate the individual mandate and then continue on with no pre-existing conditions,” Earley said during an appearance on Monday’s MetroNews “Talkline.”
“Unless you’re going to put in some kind of very robust model around re-insurance or a high-risk pool or some of those other models where actually the government’s picking up more of the cost for those truly higher risk individuals, the models without the mandate are not sustainable from an insurance perspective.”
Last week, soon after his election, Trump indicated he would support the ACA coverage requirement for people with past health issues along with the provision allowing parental health insurance to continue to cover offspring into their mid-20s.
He reiterated that during a Sunday appearance on CBS’ “60 Minutes.”
Thus far, President-elect Trump is pledging to pursue the following health initiatives, according to his campaign website:
A Trump Administration will work with Congress to repeal the ACA and replace it with a solution that includes Health Savings Accounts (HSAs) and returns the historic role in regulating health insurance to the states.
The Administration’s goal will be to create a patient-centered healthcare system that promotes choice, quality and affordability with health insurance and healthcare, and take any needed action to alleviate the burdens imposed on American families and businesses by the law.
To maximize choice and create a dynamic market for health insurance, the Administration will work with Congress to enable people to purchase insurance across state lines.
The Administration also will work with both Congress and the states to re-establish high-risk pools a proven approach to ensuring access to health insurance coverage for individuals who have significant medical expenses and who have not maintained continuous coverage.
More details were not immediately available.
The enrollment window on the ACA health insurance exchanges for 2017 is now open to people who do not have other health insurance options either through a private employer or from Medicaid which currently covers 174,020 West Virginians, according to the state Department of Health and Human Resources.
For the coming year, the average monthly premium for West Virginians seeking insurance on the exchange has risen an average of 32 percent — from $294 per month to $386 per month, DHHR reported. On average, the national increase is 25 percent.
Most of the Mountain State’s residents receive federal subsidies in some amount to help with health insurance costs, but that is not the case for 14 percent of those who buy coverage on the exchange.
The premium increases also directly affect those purchasing health insurance off the exchange.
“It’s a very difficult, very challenging situation,” said Earley ahead of his retirement at the close of 2016. “We’ve got to really address both the costs and the health conditions of those that are in the pool, but also the overall costs of the care and just how that care’s being delivered as well.”
People often view their health insurance differently than other types of insurance, Early noted.
“When you buy your auto insurance or your homeowners insurance or even life insurance, that’s a product you’re paying for that you don’t really expect to use, at least you kind of hope you don’t have to use it,” Earley said.
“Where in this case, it’s looked at from more of a consumer aspect that, ‘Gee, I’m paying this much out a year,’ albeit on an individual basis it’s a much higher price tag, but people expect to use it, not just to be there to protect them from a financial catastrophe.”
In general, better health, Early argued, translates to lower health care costs.
“People need to take better care of themselves and it’s odd that we see people making decisions to take better care of their home and better care of their cars and other decisions, more so than they would to take care of their own health and wellness,” he said.
Highmark Blue Cross Blue Shield West Virginia is the only company offering health insurance plans on the exchange in all 55 counties. In 2015, Highmark paid out $1.19 in claims for every $1 collected in premiums what Earley described as “not sustainable.”
The company’s only other competitor is CareSource, a nonprofit managed care provider based in Dayton, Ohio, which has expanded its coverage area to include 32 of 55 counties in its 2nd year on West Virginia’s exchange.
The ACA enrollment period continues through Jan. 31, 2017. The deadline to enroll for coverage to take effect on Jan. 1, 2017 is Dec. 15, 2016.
Date: November 15, 2016