With Trump ‘shouting death spiral’ for Obamacare, TN insurance commissioner wonders who’s in charge

Tennessee’s commissioner of commerce and insurance and Sen. Lamar Alexander are both quoted in a New York Times article bearing the headline, “Trump, Shouting ‘Death Spiral,’ Has Nudged Affordable Care Act Downward.” An excerpt:

Frustrated state officials have ideas for stabilizing the individual insurance market, but they say they cannot figure out where to make their case because they have been bounced from one agency to another in the Trump administration.

“We have trouble discerning who has decision-making authority,” said Julie Mix McPeak, the Tennessee insurance commissioner and president-elect of the National Association of Insurance Commissioners, which represents state officials. “We reached out to the Department of Health and Human Services. They referred us to the Office of Management and Budget, which referred us to the Department of Justice. We reached out to the White House Office of Intergovernmental Affairs.”

The Trump administration has sent mixed signals, reflecting an internal debate about whether to stabilize insurance markets or let them deteriorate further. Mr. Trump has said he could cut off the subsidies at any time if he wanted to.

…State insurance commissioners have joined insurers, hospitals and congressional Democrats in urging the administration to pay “cost-sharing” subsidies, and federal health officials initially indicated that they would do so. But Mr. Trump countermanded them, refusing to make any long-term commitment.

…Continued payment of the subsidies is “critical to the viability and stability” of health insurance markets, the National Association of Insurance Commissioners said in a recent letter to congressional leaders.

…“As long as the court case, House v. Price, remains unresolved and federal funding is not assured, carriers will be forced to think twice about participating on the exchanges,” the letter said. “Even if they do decide to participate, state regulators have been informed that the uncertainty of this funding could add a 15 to 20 percent load to the rates.”

Senate Republicans, well aware of the political risks, are seeking short-term solutions for 2018 and 2019, even as they consider big changes in a House-passed bill to repeal and replace major provisions of the Affordable Care Act.

“In order to rescue Americans from collapsing Obamacare exchanges, Republicans are likely going to have to temporarily do some things we may not like, including looking at funding the cost-sharing payments,” said Senator Lamar Alexander, Republican of Tennessee and chairman of the Senate health committee.

At the same time, he said, “Democrats will have to do some things they may not like, including allowing people to use their subsidies to buy insurance outside the Obamacare exchanges” and giving states more power to decide what types of insurance can be sold.

Note: McPeak also has an op-ed piece in The Tennessean that suggests uncertainty from Washington could figure into high premium increases she expect in the near Tennessee future. An excerpt:

I expect rate requests from insurers (for 2018 rate increases) to again be high, forcing Tennesseans to make difficult choices. And a sizeable percent of these rate requests, as BCBST wrote earlier this month, will be in response to continued uncertainty in Washington over insurance markets and regulation.

A major driver of that uncertainty is the future of cost-sharing reduction (CSR) payments for FY2017 and FY2018. My insurance regulator colleagues and I urged Congress to provide market stability by committing to fund CSR payments as Members considered the continuing resolution in April, but unfortunately markets did not receive such comfort.






3 Responses to With Trump ‘shouting death spiral’ for Obamacare, TN insurance commissioner wonders who’s in charge

  • Avatar
    Rick Williams says:

    Is that the world traveling Haslam appointed Julie Mix McPeak ??

  • Avatar
    Linda says:

    Let the “Death Spiral” triumph over the evil of Obamacare! My premiums are $19,000 this year with NO subsidy, but an $8,000 deductible!

  • Avatar
    Bob says:

    Does Linda think her premiums will go down if Obamacare ends? He he he. Newsflash Linda . Tennessee never signed on to the ACA. Your premium increases came from Nashville, not D.C.Bob

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