The big risk of repeal-and-delay (well, one big risk) is that the individual insurance market will unravel before repeal takes effect. As Robert Laszewski tartly noted, “Republicans are being awfully naïve. They seem to be ignoring the risks in the transition period, particularly because they need insurance companies to provide insurance during the transition.”
Well, not all Republicans. Christopher Condeluci, former counsel to the Senate Finance Committee and respected Republican health-care wonk, offers some insight:
I recognize this will spur questions, many of which I am unable to answer at this point, but I wanted to clarify the following: Republicans (Congressional Republicans and the Trump Administration) have certainly argued that the individual market is deteriorating, but Republicans have not announced that they want to let the individual market die. Actually, Republicans recognize that they have to fix the markets. As a result, Republicans are currently determining what steps need to be taken to improve the regulatory environment. In addition, discussions are ongoing regarding the funding for the cost-sharing subsidies, as well as payments under the ACA’s risk stabilization programs.
Some of the issues being discussed: requiring pre-verification for [special enrollment periods, or SEPs], rigorous enforcement of SEP enrollment, changing the 90-day grace period in cases where a policyholder fails to pay their premiums, modifying the age bands to 5 to 1, and fixing the risk adjustment formula (note, I recognize there are other important issues to be discussed). Republicans also recognize the insurance carrier’s desire to fund the cost-sharing subsidies, but there are political and procedural issues that need to be worked through here. While it is highly unlikely that payments under the risk corridor program will be provided to carriers, the conflict over the reinsurance payments could be resolved in a way that works for both the carriers and Republicans.
So again, Republicans recognize there is a problem, they want to fix the problem, and they are currently working to figure out what can be done, and balancing the “must dos” to stabilize the markets with the prevailing political concerns that will no doubt come from certain corners of the Republican Conference.
In the end, will it be enough? That is, if Republicans fund the cost-sharing subsidies, provide a majority of the reinsurance payments for, for example, 2016, and fix the current regulatory environment, will insurance carriers stay in the market? It’s unclear at this point. But I—like many, regardless of whether you are a Republican or a Democrat—am hopeful that the markets will be improved in short order.