The topic: Figuring out a future strategy for the state’s Obamacare exchange at a time when the president-elect and the Republican majority in Congress are plotting the demise of the law it was charged with implementing. President-elect Donald J. Trump and GOP leaders have talked of replacing the health law, but it’s not yet clear what that replacement would look like.
Rosemarie Day, president of the Massachusetts consulting firm Day Health Strategies, acknowledged that “there’s more rhetoric than reality right now.” But she said that Trump’s picks for top health care posts offered a clue to where his policies might be headed, and suggested the board must take a realistic view. U.S. Rep. Tom Price, Trump’s pick to lead the U.S. Department of Health and Human Services, is a leading Obamacare critic who has authored a plan to replace it.
You can keep your fingers crossed that important pieces will be maintained, Day said, but states should make sure they do everything they can to plan in case that doesn’t happen.
Day was a top official at Massachusetts’ health insurance exchange when it launched under the state’s 2006 health reform law, which became the blueprint for Obamacare, and spoke about what states could do on their own to regulate insurance, as well as how the exchange could maintain its viability.
Among other things, she said, Connecticut could require that individual-market insurance plans be sold through the exchange, as Vermont and Washington D.C. now require. Access Health could try to expand the populations it serves, potentially becoming a marketplace for state employees, Medicaid clients or other groups, or sell other products, like vision or life insurance, or private Medicare plans.
If the federal health law were repealed, Day said the state could establish its own individual coverage mandate or make other insurance regulatory changes, such as setting its own limit on how much more an insurance company could charge a 64-year-old than a 21-year-old. (Under Obamacare, the limit is three times as much.)
Massachusetts implemented its own individual mandate in 2007, but Day noted that that was more than a decade after the state began requiring insurers to cover people regardless of their health. As a result, before the state mandate, the individual market was expensive and mostly used by sick people. Costs went down once the mandate took effect, she said – a contrast to the situation in most states under Obamacare, which implemented the mandate at the same time insurance companies were required to cover people regardless of pre-existing conditions.
More than three-quarters of Access Health’s nearly 100,000 customers receive federal tax credits to discount their insurance premiums. But if the health law were repealed, Day said, the exchange could play a role in handling whatever mechanisms might be put in place to help people afford coverage, such as tax credits or health-savings accounts. She noted that some GOP plans to replace the Affordable Care Act call for the use of state-level high-risk pools to cover people with medical conditions, and said the exchange could potentially play a role in handling any federal subsidies made available to help people pay for that coverage.
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