Some statesare giving insurers more time this year to submit their plannedpremium rates for 2021 — based on their expected costs — hopingthings may be clearer by summer. (Photo: Shutterstock)

As doctors and consumers are forced to put most nonemergencyprocedures on hold, many health insurers foresee strongprofits.

So why is the industry looking to Congress for help?

Insurers say that while that falloff in claims for non-COVIDcare is offsetting for now many insurers' costs associated with thepandemic, the future is far more fraught.

Costs could remain modest or quickly outstrip savings. Arecession could drive revenue down. Or the coronavirus couldresurge next winter and spike treatment expenses.

Related: What health care costs will look likepost-COVID-19

All that uncertainty for the companies could trigger far higherpremiums for consumers, if insurers hedge their bets. Then again,the current savings insurers are seeing — along with cautions fromstate regulators about pushing cost-sensitive customers away duringan economic downturn — might result in minimal premiumincreases.

"Insurers are nervous, to be sure," said Michael Kreidler,Washington state's insurance commissioner. "But so far they aretelling me they are in good shape. Coronavirus claims have not beenthat high — yet."

Backing that assessment was a report out last week by creditrating agency Moody's, which looked at a range of pandemicscenarios — from mild to severe — and concluded "U.S. healthinsurers will nonetheless remain profitable under the most likelyscenarios."

Earlier this month, UnitedHealth Group CEO David Wichmann toldanalysts that cost reductions so far are outstripping expenses forCOVID-19 and that revenue is up compared with the previous year. Heexpects — barring a worsening situation — the rest of the year'searnings to match projections. Other insurers, includingCentene, Anthem, Humana and Cigna, are scheduled to releaseearnings reports this week.

If these results are repeated across the insurance industry,there will be pressure on insurers to hold down rate increases fornext year and do more for policyholders, such as constrain thegrowth in deductibles and other out-of-pocket costs, said consumeradvocates, regulators and policy experts.

"The last thing we need is insurers pricing their coverageunnecessarily high at a time like this," said Peter Lee, executivedirector of Covered California, the health insurance marketplace inthat state for people who buy their own coverage because they don'tget it through their job.

That prediction comes as tens of millions of Americans have losttheir jobs — and often their health insurance.

Those thrown out of work may be able to stay on employercoverage through a federal law called COBRA, but it's expensive andworkers have to foot the bill. Insurers and employers have askedCongress for relief legislation to fully cover COBRA costs.

Losing a job is also a qualifying event to enroll in anAffordable Care Act plan — and, again, the industry has askedlawmakers to temporarily boost subsidies to help enrollees pay their premiums. Somestates that run their own ACA marketplaces have reopened enrollmentto help the uninsured get coverage.

The industry also wants Congress to authorize temporaryfinancial support to help cover insurers that face "extraordinary,unplanned costs in 2020 and 2021," according to a letter sent tolawmakers from America's Health Insurance Plans and the Blue CrossBlue Shield Association.

To help, some states are giving insurers more time this year tosubmit their planned premium rates for 2021 — based on theirexpected costs — hoping things may be clearer by summer.California, for instance, is giving insurers until July to draw uptheir estimates.

One fear is that insurance actuaries, when faced with an unknownrisk like the coronavirus, will price higher than needed, saidLee.

Setting premiums for next year is a balancing act. Insurers thatcalculate incorrectly and go too low will lose profits and may haveto dig into their cash reserves to pay claims. If they set ratestoo high, they may run afoul of a provision in the ACA thatrequires insurers to issue rebates to policyholders if they don'tspend at least 80% of revenue on medical care.

And they don't estimate well even in normal years. Early datafor 2019 coverage shows insurers may owe a record amount in rebates, which will be paid out thisyear.

Insurers are not talking about next year's premiums.

"We do not yet know the full scope, severity or duration of thisoutbreak. So we cannot know the ultimate cost of ourmembers' medical treatment or how long the postponement ofnon-urgent care will continue," said Justine Handelman, senior vicepresident at the Blue Cross Blue Shield Association.

Early estimates, including a scary one from Covered Californiaissued in late March, warned that costs associated with thecoronavirus could drive premiums up 40% next year without federalhelp, based on initial models of the number of Americans who mightfall seriously ill.

That report, though, did not take into account the effect of thesharp decline in elective care.

Thirty-one states have barred most elective surgeries, part ofthe effort by governors to promote social distancing to flatten thecurve of the epidemic and to help prevent hospitals from beingoverwhelmed.

"The good news since we published that report is that it lookslike efforts to flatten the curve are taking effect," said Lee, socosts are more likely to be in the median rather than high end ofthe range.

The cost to insurers "all depends on the severity" of thecontinuing pandemic, said Dean Ungar, a vice president and seniorcredit officer at Moody's. "On the lower side, the industry will doquite well, and also even in a more median scenario, especiallywhen you factor in the offsetting benefit of delayedprocedures."

Moody's estimates that deferred elective procedures may accountfor as much as 20% to 40% savings on medical costs per month formany insurers as long as elective procedures are barred or patientsare unwilling to seek nonemergency care.

Even so, "I don't think the insurance industry as a whole hasany intention of making money off this," Ungar said. "There will berebates or other things to help. Partly that's the right thing todo and partly it's good business."

Former Cigna executive turned industry critic Wendell Potterdisagreed. He tweeted earlier this month that UnitedHealth spent$1.7 billion during the first quarter to buy back its own stock — amove that helps the company. "In other words, they're thrivingduring a pandemic," Potter tweeted. Instead, he said, the insurershould plow that money into premium reductions or other help forpolicyholders.

For its part, UnitedHealth said it has waived patient costsharing for COVID care — as have most other insurers — as well asaccelerated payments for what it owes to doctors, and is helpingprovide loans to some clinics.

Some physician groups fear they are being left out, saying someof the savings seen by insurers and self-insured employers shouldbe directed to those struggling after seeing their practices dry upas people avoid medical care or governors bar electiveprocedures.

"It's a huge hit," said Tom Banning, CEO and executive vicepresident of the Texas Academy of Family Physicians.

Lee agreed, warning that struggling front-line physicians, andespecially family and primary care doctors, will need financialhelp.

"A bad outcome of all this will be if thousands of providerscan't make it financially and their practices get bought up byhospitals or private entities — creating more consolidation inhealth care, which is already driving costs up," said Lee."Lawmakers should be thinking about helping primary providersout."

Kaiser Health News isa nonprofit news service covering health issues. It is aneditorially independent program of the Kaiser Family Foundation,which is not affiliated with Kaiser Permanente.