With Obamacare’s future uncertain, CT exchange contemplates strategies

One person likened it to looking at a “foggy crystal ball.” Another spoke of changing a tire on a car that’s still moving.

The topic: Figuring out a future strategy for the state’s Obamacare exchange at a time when the president-elect and the Republican majority in Congress are plotting the demise of the law it was charged with implementing. President-elect Donald J. Trump and GOP leaders have talked of replacing the health law, but it’s not yet clear what that replacement would look like.

“There’s incredible uncertainty,” said Dr. Robert Scalettar, a board member of the exchange, Access Health CT. He also chairs the board’s strategy subcommittee, which decided last month to work on plans to keep the health insurance marketplace viable. That was five days before the election.

On Thursday the group met again at the Legislative Office Building, facing a new national context. They heard from a consultant who offered suggestions for how the exchange could remain viable if the Affordable Care Act is repealed. But some members cautioned against speculating on what could happen to the health law, and said it’s important to emphasize the fact that, so far, nothing has changed.

Gov. Dannel P. Malloy’s administration is committed to the law as is, and to trying to save it, said Victoria Veltri, chief health policy advisor to Lt. Gov. Nancy Wyman.

“Unless and until something changes,” she said, they plan to move forward as is. And if something changes, she added, they will adapt.

“It’s important that we not engage in too much speculation about what will happen,” Veltri said.

Insurance Commissioner Katharine L. Wade said planning is important, but cautioned about speculation.

“What I don’t want to have happen is people get overly concerned,” she said. “This is going to play out over a long period of time, and we need to be ready, and we need to be not only reacting but looking proactively at what we can do.”

Scalettar – who likened the situation to the foggy crystal ball – agreed that nothing will happen overnight. “But better to have given it some thought and some preparation to be able to seize the moment when changes do become clearer,” he said.

And board member Paul Philpott said the exchange needs to be planning for a future that could include major changes, including the loss of hundreds of millions of dollars in federal funds that help Access Health customers pay for health insurance.

“We’re faced with what could be an existential threat,” he said.

Rosemarie Day, president of the Massachusetts consulting firm Day Health Strategies, acknowledged that “there’s more rhetoric than reality right now.” But she said that Trump’s picks for top health care posts offered a clue to where his policies might be headed, and suggested the board must take a realistic view. U.S. Rep. Tom Price, Trump’s pick to lead the U.S. Department of Health and Human Services, is a leading Obamacare critic who has authored a plan to replace it.

You can keep your fingers crossed that important pieces will be maintained, Day said, but states should make sure they do everything they can to plan in case that doesn’t happen.

Day was a top official at Massachusetts’ health insurance exchange when it launched under the state’s 2006 health reform law, which became the blueprint for Obamacare, and spoke about what states could do on their own to regulate insurance, as well as how the exchange could maintain its viability.

Among other things, she said, Connecticut could require that individual-market insurance plans be sold through the exchange, as Vermont and Washington D.C. now require. Access Health could try to expand the populations it serves, potentially becoming a marketplace for state employees, Medicaid clients or other groups, or sell other products, like vision or life insurance, or private Medicare plans.

If the federal health law were repealed, Day said the state could establish its own individual coverage mandate or make other insurance regulatory changes, such as setting its own limit on how much more an insurance company could charge a 64-year-old than a 21-year-old. (Under Obamacare, the limit is three times as much.)

Massachusetts implemented its own individual mandate in 2007, but Day noted that that was more than a decade after the state began requiring insurers to cover people regardless of their health. As a result, before the state mandate, the individual market was expensive and mostly used by sick people. Costs went down once the mandate took effect, she said – a contrast to the situation in most states under Obamacare, which implemented the mandate at the same time insurance companies were required to cover people regardless of pre-existing conditions.

More than three-quarters of Access Health’s nearly 100,000 customers receive federal tax credits to discount their insurance premiums. But if the health law were repealed, Day said, the exchange could play a role in handling whatever mechanisms might be put in place to help people afford coverage, such as tax credits or health-savings accounts. She noted that some GOP plans to replace the Affordable Care Act call for the use of state-level high-risk pools to cover people with medical conditions, and said the exchange could potentially play a role in handling any federal subsidies made available to help people pay for that coverage.

(Another suggestion, to identify other state funding to help people pay for coverage, drew laughter from the subcommittee and audience. Connecticut is facing a $1.5 billion budget deficit in the coming fiscal year.)

Access Health CEO Jim Wadleigh said the exchange isn’t moving forward with any plans to make changes, but it needs to understand the environment. “Right now, nothing has changed,” he said. “And if it does change, we’ll react to it.”