Two major insurers said this week that they wouldn't sell insurance in Iowa's Obamacare marketplace, both citing concerns about the current uncertainty around the health law's future. This means that 94 of Iowa's 99 counties will have just one insurer selling on Healthcare.gov when open enrollment starts in November.
Wellmark (Iowa's largest health plan) announced Monday that it would no longer sell coverage in the individual market. Aetna followed on Thursday, with a spokesperson telling Bloomberg it would leave the Iowa market "as a result of financial risk and an uncertain outlook for the marketplace."
Health insurers across the country are making decisions right now about whether they want to participate in Obamacare's marketplace next year. These Iowa insurers are among the first to make up their minds — and have decided that the Obamacare marketplaces are just too risky of an investment in an era of repeal and replace.
The big outstanding question is whether we'll see similar things happen outside of Iowa. Most insurers have so far stayed mum on whether they plan to sell on the marketplaces next year. The deadline to decide isn't until June 21. But they're starting to make decisions, and those will roll out over the next few months.
How much does this have to do with current repeal push? Participation in the Obamacare marketplaces was going down before the election. You probably remember the headlines from last summer when insurance giants like United and Aetna pulled out of a lot of markets. That left lots of places with just one insurer selling coverage.Insurers were already on the fence about the marketplaces. The uncertainty about what will happen next — coupled with the president's repeated predictions that the law will explode — aren't exactly inspiring confidence that this is a business worth sticking with.
“The health plans I work with want to stay in," says Robert Laszewski, a health industry consultant. "But the Trump administration is not making that easy.”
Want to know what happens next? Keep an eye on Blue Cross Blue Shield plans. There are lots of Obamacare marketplaces right now — such as in nearly all of Alabama, for example — where the Blue Cross Blue Shield plan is the only remaining insurance option. The nonprofit Blues have proven much more committed to making the marketplaces work than their for-profit competitors. Many see themselves as community plans. Before Obamacare, they were often the "insurer of last resort" — the one plan that would cover people with expensive preexisting conditions (charging a high premium, of course) when other plans would reject those customers. Forbes's Bruce Japsen has described the Blues as the marketplace's "firewall."
Wellmark, which dropped out of Iowa, is a Blue Cross Blue Shield plan. If others decide to follow its lead, then the Obamacare marketplaces will be in big trouble.
Another day, another phantom AHCA vote
There is a great line from the movie Casablanca about Captain Renault's bar tab. It's right after he orders a bottle of expensive champagne. "It is a little game we play," he explains. "They put it on the bill, I tear up the bill. It is very convenient."
As my editor Jim Tankersley points out, this appears to be what's happening on health care right now. There is the appearance of movement (an amendment! a meeting! a scheduled vote!), but at the end of the day, it does not lead to any substantive movement forward.
Case in point: This morning, the Hill was buzzing about a new health care amendment that would supposedly receive a vote in the afternoon. Offered by two Freedom Caucus members, it would provide states with an additional $15 billion to offset premiums for the most expensive patients in the individual market.
Early in the day, there was chatter that this amendment would receive a floor vote on Thursday. But by midafternoon it became clear that would not be true. Just like the last AHCA vote, it was not meant to be. It moved through the Rules Committee but did not go to the floor.This whole cycle of pseudo-activity is great for most actors involved. Republicans create the impression of making progress on their bill even when they haven't resolved key disagreements. They get to go back to their districts over recess and talk about how they're still hard at work on a major campaign promise.
Reporters (myself included!) get to write more stories about the latest twists and turns of the legislative debate.
But there is one thing that pseudo-activity is bad for: actually passing a bill. That requires real, genuine activity — and all evidence suggests there isn't much of that happening right now. The House will now be on recess for two weeks. They leave having made no significant progress on the key issues that divide the Freedom Caucus from the more moderate Republicans — namely, how much of Obamacare they should repeal. For all the discussion of a revived health care repeal effort, Republicans are no closer to passing a bill than when they started the week.
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