NASHVILLE, Tenn.—At the Fierce Health Payer Summit on Dec. 5, payer executives gave an update on the Affordable Care Act (ACA) dilemma in Congress and how it’s impacting their members and businesses.
The ACA enhanced premium tax credits expire Dec. 31, unless extended by Congress. The political fight over the subsidies, which reduce the cost of health insurance premiums for individuals on an ACA plan, has created turmoil for patients and insurers.
As of press time, dueling partisan proposals to address the expiry of the ACA subsidies both failed to advance in the Senate this week.
In a conversation with Senior Writer Paige Minemyer, executives at Oscar Health, Mountain Health Co-Op and Independence Blue Cross stressed that the ACA marketplace has significantly reduced the uninsured rate and benefits rural communities. The individual exchanges also benefit people whose employers don’t offer health coverage, executives noted.
“We have a competitive market with good risk, high volume—and look at who the market's serving,” Catherine Grason, associate general counsel and head of government affairs at Oscar Health, said. “Fifty percent of the individual market are small businesses, their employees or entrepreneurs. So these are a huge part of our GDP and our economy being served by this market.”
Blair Fjeseth, president and CEO of Mountain Health Co-Op, noted that ACA enrollment has doubled in the last five years. It has grown in the state of Wyoming, a core state for the co-op, which did not expand Medicaid.
"We really did capture a population of folks that were uninsured, and we're able to get them that coverage for the first time in a long time, if not forever,” Fjeseth said onstage. “And we're talking about small businesses, independent contractors—which there's a lot of in rural America—and farmers and ranchers.”
The expiration of the enhanced premium tax credits will disproportionately impact rural families and businesses, executives said. Without the credits, premiums will skyrocket, and many people will no longer be able to afford the health insurance plan they have come to rely on.
“The people who aren't going to be signing up for coverage and going without, they're going to be going back to rationing insulin, they're going to be going back to deciding whether they pay their bills or their insurance, and then they're not going to get care,” Fjeseth said.
Moreover, Grason explained that the expanded coverage has bolstered rural hospitals by compensating them for the care they provide. She warned that the expiration of the subsidies would be a detriment to rural hospitals, which might have to close.
Fjeseth asserted that the tax credits have helped bring more behavioral healthcare, transfusion centers and cancer treatments to rural areas due to the increased number of insured individuals.
“Somebody going without coverage in a small rural town means that likely the breadwinner of a family, if something happens to them and they're not covered, that's generations' worth of debt, that is a big deal. That's farms getting taken away, that's businesses getting taken away, that's Front Street being impacted. There's not enough GoFundMes to pay for somebody's cancer care when they don't have coverage. The cancer center, the one in Wyoming, is charging $55,000 an infusion. That's the struggle we're facing."
As of the day of the panel Dec. 5, there had been 14 proposals on the future of the ACA this year, Grason said. She spoke of the confusion Congress has created for health plans and individuals with ACA plans.
The uncertainty in Congress has created real stresses on their businesses and members, the executives said. “We've had to reprice our plans like three times for Oscar in 20 states. So people are exhausted," Grason said.
Julie Bogorad, director of the office of public policy at Independence Blue Cross, said the state of Pennsylvania has been proactively communicating with constituents about the possible rise in prices. She expects the expiration of the subsidies to bulldoze the progress made by the state-based marketplace, Pennie.
“I think we're seeing a lot of member fear, too,” Bogorad said. “You know, they've gotten used to having access to a plan since COVID, which was a scary time, and now you associate security and stability with this health plan that you can afford. I know we're getting a lot of calls.”
Because the plans don’t have any more of a clear answer on the future of the subsidies than their members do, it’s been difficult to know how to communicate with them.
“There's nothing we can tell them to reassure them, or say for sure: This is what's happening,” Fjeseth said.
Grason and Bogorad spoke about the benefits of the individual coverage health reimbursement arrangement, a regulation put into place by the first Trump administration. The rule allows employers to give tax-free funds to employees to select the plan that works best for them on the individual market.
Grason stressed that it should be codified into law. A bill called the CHOICE Act was passed by the House in one version of H.R. 1, but the line item was tossed by the Senate.