Health

The Hill: “Health insurance executives went to the White House on Monday and called for changes to Obamacare that they say are necessary to keep the healthcare exchanges working.”

“The executives discussed a series of their long-running complaints about ObamaCare including tightening up the rules for extra sign-up periods, shortening grace periods for people who fail to pay their premiums and easing restrictions on setting premiums based on someone’s age.”

“The insurance officials called on the administration to enact a system where it checks enrollees’ documentation to make sure they are eligible for extra sign up periods before they sign up, as opposed to after they are already enrolled, industry sources said.”

Los Angeles Times: “As insurers exit Obamacare marketplaces across the country, critics of the Affordable Care Act have redoubled claims that the health law isn’t working.”

“Yet these same critics, many of them Republican politicians in red states, took steps over the last several years to undermine the 2010 law and fuel the current turmoil in their insurance markets.”

“Indeed, eight of the nine states where consumer choices will be most limited in 2017 have rejected Medicaid expansion and taken other steps that have weakened their marketplaces, data show.”

“19 states are still rejecting federal aid to expand their Medicaid programs to poor, childless adults, a group of Americans traditionally excluded from the government safety net.”

“This has been particularly problematic for those states’ marketplaces, research suggests, as many poor – and probably sick – residents who couldn’t get Medicaid have gone into the marketplaces.”

New York Times: “Here are four key challenges to the program and a survey of some possible solutions.”

One: “Choice is disappearing.”

“Possible solutions: Both President Obama and Hillary Clinton have also revived the idea of the so-called public option, which would be a government-run plan that would either compete with or be a substitute for a plan offered by a private insurer.”

Two: “Prices are rising.”

“Possible solutions: Bring down costs instead of raising prices… the narrow network strategy may be a smart way to start getting different groups to negotiate down on their prices… Another, simpler way to bring down prices would be to get more healthy people into the market, so the average insurance customer costs less, or use other tools to absorb the cost of people with complicated and expensive medical conditions.”

Three: “The market is too small.”

“Possible solutions: Change the incentives, so more people who are currently uninsured buy health insurance. Hillary Clinton has talked about giving out more generous subsidies, so insurance costs less and more people can afford to buy it. Many Republican politicians suggest another way to lower prices: eliminating current requirements that insurance cover a wide array of services. Some policy experts, including Uwe Reinhardt, a Princeton health economist, in a recent Vox.com interview, have suggested tightening up the penalties for remaining uninsured, so people can’t wait and buy insurance only after they get sick.”

Four: “The rules are complicated.”

“Possible solutions: The insurers that remain in the market — particularly many Blue Cross plans — have a long list of policy requests that would make their business less risky: by making it harder for sick people to buy coverage for short periods of time, by subsidizing the plans’ losses for very expensive patients, and in some cases by charging higher prices to older customers, who are more likely to be sick. But regulators have been cautious about embracing them, because such moves would shift financial risk to taxpayers and make it harder for people who need health care to get insurance.”

Two new fairly comprehensive Obamacare analyses can be found on Vox.

“Is Obamacare failing?”

“The marketplaces’ failures to attract a robust group of health plans to many areas suggests that Obamacare’s insurance expansion is on the path to looking like other safety net programs we know, offering limited services to a predominantly low-income population.”

“Big insurers have quit Obamacare. That means more shoppers only get one choice.”

“Major insurers like Aetna and UnitedHealth have, in recent months, taken major steps to sharply reduce participation in Obamacare’s insurance marketplaces. The result, a new Vox analysis shows, is a spike in counties served by just one health plan — and a precipitous drop in ultra-competitive areas.”

See also “Is Obamacare Sustainable?” from The New York Times, in which health policy experts and leaders debate Obamacare’s future.

The Hill: “Aetna’s retreat from most Obamacare marketplaces this week is rippling across rural America, starting with Pinal County in Arizona.”

“The county, which has a population of about 400,000, no longer has any insurers planning to sell coverage through ObamaCare next year.”

“State regulators still have until Aug. 23 to try to lure other companies into the marketplace, but it could be a tough sell after one of the nation’s largest insurers decided to pull back because of costs.”

“Aetna announced late Monday that it would pull out of ObamaCare exchanges in 11 states, including Arizona, Florida and Texas. The company’s CEO, Mark Bertolini, cited $200 million in losses over the past few months as a major reason for the move.”