Both insurance companies and regulators are struggling to cope with the uncertainty that has ensued in the wake of the failure of Republicans to repeal and replace the Affordable Care Act with their own plan, the American Health Care Act.

And it’s not just the legislative failure that threatens the survival of health insurance — the president’s threats, after Congress couldn’t pull off its repeal-and-replace plans, to let the ACA program “explode” are making insurers very wary of staying in the marketplaces set up by passage of the ACA under President Obama.

Insurance Journal reports although insurers haven’t declared their intentions yet, two strong possibilities could cripple the program are major increases in premiums and the departure from the marketplace by companies that aren’t satisfied with either the results so far or the potential for improvement.

Although insurers view April 30 as the target for deciding whether they’re in or out, based on President Trump’s threat to stop payments that subsidize copays and other upfront costs for lower-income people, they haven’t said definitely what their plans are. But in May, they’re expected to start filing with regulators concerning their future in the program.

Without the subsidies, insurers would probably either increase premiums or drop out entirely — but the administration, according to the report, “has refused to commit to keeping the payments going.”

Regulators fear a mass exodus by insurers from the markets — or major increases in premiums — will render the ACA coverage unattainable to many. And insurers aren’t talking — yet.

“Everybody is still in a wait-and-see mode,” Kristine Grow, a spokeswoman for the industry group America’s Health Insurance Plans, is quoted saying in the report. AHIP, along with other industry groups, is trying to win a commitment from the administration to keep making the cost-sharing payments. Grow adds, “Plans really need certainty.”

But people seeking to buy insurance aren’t the only ones who will suffer if the chaos spreads — hospitals could find themselves on the hook for care provided to those who can’t get insurance but still must seek treatment.

The irony is that some insurers were looking at a rosier financial picture before all the chaos erupted around the battle over failure to pass the AHCA, which contained provisions at once too harsh for Democrats and moderate Republicans while being far too lax to satisfy conservative Republicans.

Threats to cut the subsidies and political uncertainties about major changes to the law are threatening what otherwise would have been a profitable 2018, the report says, citing an S&P Global Ratings analysis of Blue Cross and Blue Shield health plans. The plans boosted rates more than 20 percent on average for this year, S&P said,

“The price increases they’ve put in as well as the network design changes, that’s going in the positive direction,” Deep Banerjee, the S&P analyst who wrote the report, is quoted saying. But he points out that the fate of the cost-sharing payments is a major uncertainty. And if the Republican ACA repeal bill changes things in 2018, “then all bets are off.”

Instant Insights /

Insurers riding wave of chaos in ACA planning coverage

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