As Republican senators push their undecided colleagues to support the Graham-Cassidy bill ahead of a September 30 deadline, insurance companies are struggling to figure out what the bill means for them.
A few weeks ago, before the Graham-Cassidy bill became the sole focus of the health care debate in Congress, the Senate had been working on a bipartisan deal to stabilize the Obamacare marketplaces. But that effort has been abandoned in favor of a last-ditch Republican effort to repeal Obamacare, and insurers are once again facing enormous uncertainty about how the individual marketplaces will operate in 2018.
No matter what happens to the Senate bill, insurer have to finalize their premium rates for next year by September 27, less than a week away. It will be particularly difficult to set those rates without commitments from Congress and the administration on maintaining the cost-sharing reduction payments that play an important role in insurer profitability. The White House has threatened to eliminate those payments in the past, adding a layer of risk for insurers that could result in big increases in premiums for 2018. It could even drive insurers out of the market altogether, leaving some counties without coverage.
Sabrina Corlette of Georgetown University’s Center on Health Insurance Reforms said in The Hill, “I think what’s worrying them is the unpredictability of this administration and the unknown that they cannot price for … And so that is causing, I imagine, many sleepless nights among insurance executives right now.”
If Graham-Cassidy does pass, insurers will face another, even larger problem: an entirely new landscape for health insurance in the U.S. The bill would provide states with huge block grants to use for health care and health insurance coverage, but each state would have to figure out what to do with that money. Larry Levitt of the Kaiser Family Health Foundation said the legislation creates “formidable” challenges for states, which would be starting from scratch as they develop health systems to serve millions of people. It’s unlikely that all 50 states would be up and running by January 1, 2020, the day the new system would go into effect.
Peter Lee, the director of California’s health insurance marketplace, said in The New York Times: “The metaphor I think about is it’s saying, ‘We’re going to continue having a freeway full of fast-moving cars, but we’re going to remove the lane line and the speed limits and say we hope things work out.’ ”