On the Record with Eric Borgerding, Wisconsin Hospital Association CEO
Wisconsin Hospital Association CEO Eric Borgerding says doing nothing on healthcare reform isn’t an option for federal policymakers.
The decision by Republican lawmakers to pull their healthcare reform bill from a vote last month has “exacerbated” uncertainty surrounding the individual insurance market, he warns.
Congress and President Donald Trump’s administration could help by being clear about what they plan to do next, he said.
“I think the sooner we have at least answers on that, the better,” he said.
Borgerding recently spoke with Wisconsin Health News. Edited excerpts are below.
WHN: In a statement released after Republican lawmakers pulled the bill, you said there are “serious public policy issues” remaining around the federal health reform law. What do you see as the most serious?
EB: Our top priority from the day after the election has been sustaining Wisconsin’s coverage gains. Those have come in two forms. One, of course, is the Medicaid expansion that we did do, adding 130,000 people below 100 percent of the federal poverty level, but also the 240,000-plus people who’ve selected coverage on the exchange in 2017 and the 80 percent of those who are receiving assistance, a subsidy, to help with their premiums. Right now, those subsidies are based upon their income. If you take the Wisconsin model and you look at the American Health Care Act and the repeal and replacement of Obamacare from the perspective of the Wisconsin model, what is it that concerns us? What we’ve been hearing is that the Affordable Care Act exchanges are imploding. I think that’s true. I think that varies from state to state, the degree to which the exchanges are starting to falter a bit. That’s generally driven by, No. 1, premiums and, No. 2, the amount of competition, the amount of choices available on those exchanges. If that’s accurate – if the ACA left alone like it is right now or not affected in some way administratively by the Centers for Medicare and Medicaid Services, is going to continue to spiral downward – I don’t think that is an alternative to the ACA, letting it fail. I think that the question becomes: Will there be something done in the meantime to shore up the insurance markets? There’s some work being done on that. What’s going to happen next in Congress? Is there going to be the urgency to essentially fix Obamacare before we can replace Obamacare?
That’s kind of the situation we’re in right now. Wisconsin very purposefully relied on affordable, subsidized premiums in the exchange to move forward with rejecting Medicaid expansion, lifting the enrollment freeze for those below 100 percent FPL and disenrolling about 70,000 others that are above 100 percent FPL. A key component of what we did to expand coverage – including rejecting Medicaid expansion à la Obamacare – hinges on the existence of very low cost premiums on the exchange. If you step back and look at what Wisconsin did, we, out of necessity, need a plan B. We want to see something move forward that at a minimum addresses and shores up the exchanges and preserves the subsidies for purchasing insurance either on the exchange or some other way. Those are critical elements of what Wisconsin did. Just sitting here and watching something fail is not an option from our perspective. We did too much in this state. We purposefully relied on those exchange in the state. We have to purposefully be an advocate for making sure that we sustain the coverage gains that we’ve achieved.
WHN: What should be in a plan B?
EB: I think that they have to take a hard look at what is causing premiums to go up, at what is causing insurers to decide to withdraw from the exchanges and take public policy steps aimed at alleviating those dynamics that are causing insurers to apparently see the exchange population as too risky. I think that’s being driven in part by the fact that not many young people are signing up. I think there’s a lot of ideas on the table about how to do that. But I think it’s incumbent upon Congress to pick that up again and not just let this fail. I honestly believe now that Congress has attempted to repeal and replace Obamacare and at least for now has set that aside, I think Congress owns what happens. If the exchanges and the insurance market fail, I think it’s going to be very hard for Congress to stand back and say, “Well, we didn’t create this law, so its failure is not on our hands.” The fact is they have an opportunity still to come back and try to stabilize the market, the exchanges, those things that have been important to the Wisconsin model. Let’s see what that is. And maybe do this incrementally, rather than trying to bite off all of these things in one chunk, including things that are very controversial like Medicaid expansion. Taking away Medicaid expansion has a fair amount of Republican opposition. Maybe plan B is let’s try to do certain things incrementally. Let’s first and foremost prioritize what we have to do to solidify and stabilize the insurance market and get a deal to do that as opposed to trying to repeal and replace the whole thing. Because I really do think that what happens next is owned by Congress more than maybe some want to own it.
WHN: There’s been some talk about what Health and Human Services Secretary Tom Price could do to address instability. Do you think this requires a congressional solution or is there enough regulatory authority to stabilize the market?
EB: That in part remains to be seen. I think it’s not only a question of what can be done. It’s a question of what do people want to be done or what are they willing to do. My point is let’s have that discussion. Let’s get on with strategies to stabilize the market. If that can be done in a way that makes sense, in a way that preserves the existing income-based subsidies at least for now, which are such an important part of the Wisconsin model, then let’s get that on the table and start moving on what can be done. I can understand taking a pause for a while and trying to figure out what’s going to be the next step. We have the president now talking about reaching out to Democrats. I think that’s more of a strategy to try and get Republicans back to the table and in a more unified way. But whatever the mechanism for doing this is, I don’t think doing nothing can be the option.
WHN: Do you have any concerns regarding the House GOP’s lawsuit against the administration challenging the constitutionally of subsidies to insurers that offset out-of-pocket costs?
EB: It’s become sort of a catch 22. It was an interesting strategy to try and cripple Obamacare prior to the election. But now that the election’s happened and now that the effort to repeal and replace Obamacare has been set aside at least temporarily, you’re sort of faced with a situation of – like I said earlier – it’s almost ironically like Obamacare has to be repaired. Obamacare in a way can’t be dismantled yet until there is a game plan that can get to the president’s desk about how to replace it. That’s the situation we find ourselves in. To the extent that lawsuit would dismantle a really important element of ensuring affordability of health insurance in our current system, I think it almost can’t go forward.
WHN: Some conservative Republican lawmakers think getting rid of regulation, like the essential health benefits required by the law, could lower the cost of insurance. How do you feel about undoing that requirement and the protections around pre-existing conditions?
EB: We’re concerned about that obviously. But our concern becomes less to the extent that the ability remains of states to determine those. Prior to the ACA, with a few certain exceptions for fully insured plans, states were largely responsible for determining what the mandated benefits are. And I feel pretty comfortable about where Wisconsin would be on that. I think that it really boils down to is, if essential benefits are done away with, to what extent are state’s able to determine what benefits must be included, preserved? I think that’s a key element. To the extent that Wisconsin is still able to determine what types of benefits will have to be offered in fully insured plans, then my concern about that is lessened.