Health care leaders to Congress: Stabilize insurance market

Don't expect reform of the Affordable Care Act to be tabled or resolved any time soon.

Debate over how to replace or repair the controversial federal health law is projected to run through the end of the year and probably into 2018 — and it certainly won't be wrapped up in the next six months, according to leaders of two of the county's weightiest health care organizations who spoke Thursday on a panel hosted by the Nashville Health Care Council in Cool Springs.

It's going to be tough to find consensus on legislation in both the House and Senate, agreed Marilyn Tavenner, president and CEO of America's Health Insurance Plans, and Rick Pollack, American Hospital Association's president and CEO. 

And the impact of this week's recess — which has seen some Republican lawmakers, including Rep. Marsha Blackburn, R-Tenn., confronted by constituents opposed to wholesale repeal — is yet to be seen, said Pollack. Blackburn encountered many pointed comments and questions from a packed town hall in Fairview on Feb. 21.

Hundreds press Marsha Blackburn for answers at town hall

But in what Pollack called a traffic jam of issues, both he and Tavenner agreed that Congress should move on actions to stabilize the individual health insurance exchange for 2018.

Uncertainty about funding mechanisms and participation in the exchange is causing some insurers, notably Humana, to vow a departure in January. In Tennessee, the decision — unless reversed or replaced by another insurer — will leave the greater Knoxville area without an insurer on the exchange, which is the platform on which shoppers receive subsidies to help with premium costs. 

Because of the process by which insurers price plans for future years, the industry needs clarity to navigate the rest of the decade. 

"We need to understand what is going to happen ... in 2018 and 2019 at the minimum," said Tavenner. 

A plan "for whatever 'R' word you want to use" should kick in no sooner than 2020, she said, referring to calls to repeal or replace the law. She added that some Senate members think even that would be too soon to allay industry disruption.

Humana exit shakes up 2018 ACA exchange, leaves Knoxville coverage gap

However, panic is already gripping people around the state as they try to understand what their options will be, or speculate on whether they will have an insurer in their region next year. A decision by either BlueCross BlueShield of Tennessee or Cigna would leave other regions in the same position as greater Knoxville. 

Dennis Wallace a self-avowed Republican from Hixson, Tenn., who voted for President Donald Trump is featured in an advertisement spot paid for by Save My Care, a group that supports the ACA, as an every day person who benefited from a plan bought on the exchange. A pre-existing condition prevented him from getting a policy before the ACA, but the law enabled him to get care for esophageal cancer.

In the ad, he and his grandson ask viewers to tell Congress to save the ACA.

It's not clear to Tavenner, or the state's insurance commissioner, Julie Mix McPeak, that action in the next month could prevent more departures from the 2018 exchange.

Sen. Lamar Alexander, R-Tenn., is an outspoken proponent of Congress taking steps to make sure Americans can still buy insurance on the exchange next year. Alexander and Sen. Orrin Hatch, R-Utah, will be key Washington leaders in the coming months, said Tavenner. 

Conversations around Medicaid, and whether to block grant it or not, and employer-sponsored coverage will linger far beyond what happens with next year's exchange, Pollack and Tavenner said. 

Each set of reforms will bring a political challenge, they said.

Reach Holly Fletcher at hfletcher@tennessean.com or 615-259-8287 and on Twitter @hollyfletcher.