President Trump on Monday met separately with health insurers and governors to discuss his administration's health reform efforts.
The meetings come as insurers weigh whether to participate in the Affordable Care Act's (ACA) exchanges for the 2018 coverage year. Humana earlier this month said it would not participate in the exchanges next year.
Trump's meeting with insurers included leaders from:
- America's Health Insurance Plans (AHIP), a key insurer lobbying group;
- Blue Cross Blue Shield plans;
- Kaiser Permanente; and
- UnitedHealth Group.
A spokesperson for Molina Healthcare said the insurer, which provided exchange coverage to 526,000 people in 2016, was not asked to attend the meeting and that company leaders were unsure why.
Trump in his public remarks criticized the ACA for imposing health coverage requirements that he said limited the types of plans insurers could sell. He told insurers, "We must work together to save Americans from Obamacare ... to create more competition and to bring down prices substantially."
Trump told insurers that he had directed HHS Secretary Tom Price to work with them "to ensure a smooth transition to" an ACA replacement plan, but Bloomberg reports he offered few new details on what that plan could entail. Trump said that he would like to expand health care savings accounts and allow insurers to sell plans across state lines. Trump last week said that a more detailed health reform proposal could come as early as March.
Trump also said that his address to a joint session of Congress Tuesday would provide "something special" on his health care replacement efforts.
"The new plan will be a great plan for the patients, for the people, and hopefully for the companies. Going to be a very competitive plan. And costs will come down and I think the health care will go up very, very substantially," Trump told insurers. "We've taken the best of everything we could take."
Anthem CEO Joseph Swedish during the public portion of the meeting praised Trump's administration for proposing insurance market regulations earlier this month that would tighten special enrollment period eligibility. The regulations were widely praised by the insurance industry, which expects that they will help prevent individuals from waiting until they get sick to purchase insurance, but criticized by consumer advocates, such as Families USA.
Insurers after the meeting appeared hopeful about the future of health reform. Aetna CEO Mark Bertolini, who has been critical of the ACA exchanges, told reporters that Aetna would like to work with the administration and Congress on a "broader range of solutions that Americans will find valuable in managing their health care needs." He said, "Everyone who took part in today's meeting shares a common goal—ensuring every American has access to affordable health care."
AHIP in a statement said the meeting was focused on both "short-term stability and long-term improvement" and that the group looked forward with working with the Trump administration going forward.
Trump also met with governors this week as they gathered in Washington, D.C., for the National Governors Association's winter meeting.
During his meeting with governors on Monday, Trump called the ACA "a failed disaster," but he acknowledged the complexity in repealing and replacing the law. Trump said, "Nobody knew that health care could be so complicated." He added, "As soon as we touch it—if we do the most minute thing, just a tiny little change—what's going to happen? ... They're going to say it's the Republicans' problem. That's the way it is, but we have to do what's right."
Trump said that, despite the challenges, Republicans would press on with their plans to repeal and replace, saying he supports proposals that would give states additional flexibility to meet the needs of their populations.
Virginia Gov. Terry McAuliffe (D) and Nevada Gov. Brian Sandoval (R) after the meeting told reporters they both left the meeting with the impression that the HHS secretary would draft a health reform plan along with congressional lawmakers.
McAuliffe said, "The way I felt, I think [HHS] Secretary Price was going to be coming up with a plan," adding that it seemed "pretty clear." According to McAuliffe, Price said such a plan could be ready in three to four weeks, but Trump responded he hoped to see a plan in two weeks.
GOP lawmakers remain divided on ACA repeal plan, tax credits
According to The Hill, if Trump and Price were to propose a separate White House health reform plan, the result could be additional turmoil in the ongoing debate in Congress about repealing and replacing the ACA. Congressional Republicans are still weighing a range of possible approaches to reform, and on Monday two prominent Republicans signaled their opposition to a leaked draft bill to replace the ACA.
Rep. Mark Meadows (R-N.C.)—who chairs the conservative House Freedom Caucus, which consists of about 40 conservative lawmakers—said he would not support the leaked bill, in part due to proposed tax credits to help individuals purchase coverage that he likened to an "entitlement program."
Rep. Mark Walker (R-N.C.), chair of the 170-member Republican Study Committee, also said he would not vote for the leaked draft bill, saying, "The bill contains what increasingly appears to be a new health insurance entitlement with a Republican stamp on it."
According to Axios, if the two lawmakers were joined in their opposition by most of the members of the groups they lead, House leaders likely would not have enough votes to pass the bill. But if GOP leaders attempted to address the concerns by eliminating or reducing tax credits, the Senate would be unlikely to pass the bill, Axios reports, due to concerns that it would not provide U.S. residents a way to buy affordable coverage.
House staffers have declined to comment on the authenticity of the leaked proposal, which was dated Feb. 10.
Top Democrats critical of GOP plans, Trump meeting
House Minority Leader Nancy Pelosi (D-Calif.) in an appearance on ABC's "This Week" said she is doubtful Republicans will be able to repeal and replace the law, saying, "They don't have the votes."
Senate Minority Leader Chuck Schumer (D-N.Y.) also criticized Republican efforts to repeal and replace the ACA, as well as Trump's meeting with insurers. He said the meeting suggests "the special interests are getting their way at the expense of working Americans—less coverage, higher premiums, fewer sick people insured."
(Tracer et al., Bloomberg, 2/27; Humer/Abutaleb, Reuters, 2/27; Lee, CNN, 2/27; Sullivan, The Hill, 2/27; Nather, Axios, 2/28; Radnovsky et al., Wall Street Journal, 2/27; Howell, Washington Times, 2/26; Livingston, Modern Healthcare, 2/27).
The 2017 State of the Union: Health care reform beyond the ACA
The new administration and Republican-controlled Congress have big plans to repeal and replace the ACA, causing tremendous uncertainty in the health care industry.
To help navigate this uncertainty, this webconference will focus on what we know now about the repeal and replacement plan, as well as what we can expect in the weeks and months to come. Additionally, at this critical juncture point for the future of the ACA, it is only fitting to pull up and reflect on the successes and failures of the ACA as a whole across the past eight years.