The health insurance industry’s Obamacare drama reached a climax on Tuesday, but it isn’t over.

The health insurance industry’s Obamacare drama reached a climax on Tuesday, but it isn’t over.

With Senate Republicans’ failure to advance their bill to replace Obamacare, insurers are facing a summer of uncertainty. President Donald Trump’s administration won’t commit to making critical payments under Obamacare. Health plans have pulled out of some markets, and raised rates in others. And there’s always the chance that Republicans could revive their effort to repeal the law.

“Our members and all Americans need the certainty and security of knowing coverage will be available and affordable for them,” said Justine Handelman, senior vice president of policy and representation for the Blue Cross Blue Shield Association.

The next key moment comes in two days. That’s the date when the administration — which has threatened to let Obamacare fail — is scheduled to make its next monthly subsidy payment to insurers under the ACA. Known as cost-sharing reduction payments, the subsidies were created by Obamacare to help low-income people afford to use medical services, and their legitimacy is the subject of a legal dispute.

So far, the White House — which has threatened to halt the subsidies in the past — hasn’t committed to making the payment.

“Of course it’s always an option” not to make the payment, said Sean Spicer, the White House press secretary. “We have a couple days left.”

Lobbying Push
The Blue Cross Blue Shield Association said it has “consistently urged that there be immediate, certain funding for the cost-sharing reduction program.” The insurers that sell under the brand collectively cover more than 100 million people in the U.S.

For some insurers, the best way to deal with the uncertainty around Obamacare has been to back away from it.

On Tuesday, UnitedHealth Group Inc., the U.S.’s biggest insurer, showed the benefits of avoiding the political minefield the law has become. It reported second-quarter profit that beat estimates and raised its 2017 forecast after turning its business away from the ACA’s individual markets and more toward Medicare, Medicaid and coverage sold to employers.

With Republicans in Congress reeling Tuesday from the failure of their latest Obamacare repeal effort, the health care industry is facing an accumulation of “ifs.” Obamacare’s insurance markets still have problems. Trump has many powers at his command to undermine them further. And there’s no map and no timeline by which lawmakers might find a resolution.

‘No Clear Path’
“There is no clear path out of this,” said Robert Laszewski, an insurance industry consultant who has been critical of Obamacare. “Individual markets continue to spiral downward partly because of the inherent issues in Obamacare’s market architecture and partly because of Republican efforts to make things even worse.”

Humana Inc. and Aetna Inc. have retreated from the law, and Anthem Inc., a key Obamacare player, has announced plans to quit or limit its presence in at least four states. The industry has cited the volatile politics around Obamacare as a reason for their pullback.

The next step in Congress is unclear. Senate Majority Leader Mitch McConnell proposed holding a vote to repeal Obamacare without a replacement plan, on a two-year delay. But enough GOP senators quickly said they opposed that plan to effectively kill it.

Trump Threat
Meanwhile, Trump expressed support for a plan sure to dismay insurers.

“We’ll let Obamacare fail and then the Democrats are going to come to us,” Trump said Tuesday at the White House. “We’re probably in that position where we’ll let Obamacare fail. We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it.”

Kristine Grow, a spokeswoman for America’s Health Insurance Plans, another lobbying group for insurers, declined to comment directly on Trump’s threats. “We remain committed to working with every policy maker and the administration to ensure the short-term stability and long-term improvement of health care,” she said.

A third insurance group, the Association for Community Affiliated Plans, said it also wanted lawmakers to try and stabilize the ACA. “We believe there are a number of fixes needed to stabilize the individual market, such as guaranteeing funding for cost-sharing reductions and ensuring that coverage is truly affordable for consumers,” said Margaret Murray, the group’s chief executive officer.

Aetna launches new health plan

Sutter Health, a not-for-profit health care system in Northern California, and Aetna have announced plans to launch a jointly owned health plan. This new collaboration, the first of its kind in Northern California, will bring together

Sutter Health’s network of doctors and hospitals with Aetna’s health plan expertise, and shared care management capabilities.

Sutter Health and Aetna anticipate offering self-insured commercial products starting mid-2018 in the greater Sacramento, Central Valley and Bay Area communities, as well as fully insured PPO products to follow in early 2019, pending regulatory approval.

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This new company will complement Sutter Health’s and Aetna’s current products by providing more choices to Northern California’s commercially and self-insured populations.

By equally sharing ownership and accountability, Sutter Health and Aetna aim to “integrate the continuum of care delivery, from wellness to disease management, care coordination, and access.” The joint venture will also streamline administrative services for members.

The JV is hoping to use combined data analytics to identify at-risk patients sooner and provide them with earlier access to care by expanding access to alternative sites of care, and using advanced population health technology to help members better manage chronic and other health conditions.

“We are excited to partner with Sutter Health on this joint venture,” said Mike Bahr, Aetna’s senior vice president of local markets and territories. “With Sutter Health, we believe we have found a strong partner that shares our vision to transform health care in Northern California by providing members with a simpler, more personal experience.”

“Patients benefit when providers and health plans share resources and work together,” says Phil Jackson, Sutter Health’s CEO of Health Plan Products. “Our Sutter Health and Aetna insurance product offerings will provide employers with new self-funded and fully insured PPO options in Northern California.”

Currently, Sutter Health-affiliated providers care for more than three million Northern California residents. Aetna provides health care benefits to approximately 415,000 members in Northern California.

Aetna projects to have at least 75 percent of its claim payments in value-based models by 2020.

PR Newswire