Beltway insiders struggle to predict what will happen to health insurance exchanges, essential benefits

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From left: Leah Ralph of ACCC, Dan Todd of Todd Strategy, and Dr. Kavita Patel of The Brookings Institution at Cancerscape conference by the Association of Cancer Care Centers in Washington, D.C.  Photo: Andrew Zaleski

Mix concern for the future well-being of the insurance exchange market along with a healthy dose of ¯_(”/)_/¯ and you’ll have a decent analysis of healthcare in the U.S. circa 2017.

At the Association of Community Cancer Center’s 43rd annual meeting this week in Washington, D.C., there was a discussion about the state of healthcare under President Trump’s administration — a timely subject, given the recent failure of House Republicans to pass the American Health Care Act (AHCA), their repeal and replace version of the Affordable Care Act, or what’s commonly known as Obamacare.

Moderated by the ACCC’s director of health policy Leah Ralph, the discussion included Dr. Kavita Patel of the Washington, D.C.-based think tank The Brookings Institution and Dan Todd of Todd Strategy. As former Capitol Hill staffers, both offered instructive comments on congressional Republicans’ failure to pass the AHCA.

“The House is always this kind of chaotic, welcome-to-the-jungle kind of mess,” Patel said. “Bottom line: They didn’t have the votes.”

Todd echoed the sentiment, also noting that a dose of political miscalculation led House Republicans to believe all their members would vote for an Obamacare repeal bill. In recent days, members of the GOP have blamed the Freedom Caucus, the more conservative wing of the Republican Party in the House, for scuttling the AHCA. (Notably, President Trump tweeted this admonishment: “The Freedom Caucus will hurt the entire Republican agenda if they don’t get on the team, & fast.”). This happened about eight minutes before the discussion on Thursday.

Political dynamics aside, what does any of this mean for cancer treatment in the U.S., and the general state of healthcare? That was the question both Patel and Todd tried to make sense of for conference attendees.

The insurance exchange marketplace is where about 10 million people currently get their insurance, and how it fares in the year ahead is what Todd tackled head-on. Since passage of the ACA seven years ago, it’s now apparent that the small group market doesn’t look like the large group market — it looks much like the Medicaid market, made up of people who are sicker and older, and is highly cost-sensitive. The fix employed by President Obama’s administration, which wasn’t contemplated in the original healthcare law, was a risk adjustment payment paid to plans.

“Will the Trump administration make those payments like the Obama administration did? My gut tells me no,” Todd said. “If no, you don’t have a healthy market.”

Patel responded in kind, noting that if the Trump administration does away with cost-sharing subsidies, the result will be “people who have cancer who can’t afford insurance.” The reason? The financial stability of the federal healthcare marketplace will begin to falter. So far, the Trump Administration hasn’t said one way or the other whether it will continue providing those subsidies for insurers who participate in the federal marketplace, although House Speaker Paul Ryan said that the Trump administration should keep making those payments to insurers “to avoid destabilizing the market,” the Wall Street Journal reported Thursday.

Patel also highlighted the essential benefits component of the ACA, which required all plans sold in the marketplace to cover cancer screening, treatment, and follow-up care. The ACA tied out-of-pocket maximums paid by patients to essential benefits.

Health and Human Services Secretary Tom Price has signaled that Republicans will dismantle elements of Obamacare even without the votes in Congress. As the Chicago Tribune reported, Price described in testimony this week how “his department could make insurance plans cheaper by scaling back several federal mandates, including what the ACA currently defines as ‘essential benefits’ in coverage.”

“You get rid of [essential benefits], you actually get rid of those out-of-pocket annual maximums, which are crucial for cancer patients,” Patel said.

Although both the White House and Ryan vowed they would renew their efforts to repeal the ACA, it’s too soon to tell what will happen with healthcare this year.

Put another way: ¯_(”/)_/¯.

Featured photo: Justin Sullivan, Getty Images

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