Here’s how to address the inevitable challenges to the individual market

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Another opportunity to stabilize the individual market came and went last month, with the passage of the omnibus spending bill for 2018. President Trump had promised Sen. Susan Collins (R-Maine) that if she voted for individual mandate zero-out, the Affordable Care Act (ACA) individual market stabilization plan she proposed with Sen. Lamar Alexander (R-Tenn.) would be included in the spending bill. Alas, this did not come to be and now the popular consensus among experts is that there will not be a legislative solution until after the midterm election.

Now as we find ourselves in the time of year when health insurers must submit plans and rates to state departments of insurance to start the approval process for 2019, it appears that insurers — and their consumers — are on their own.

{mosads}The timing could not be worse and it presents a myriad of challenges, with the individual market, consumers and their health insurers certain to feel effects of legislative and regulatory activity in various ways. This is hardly up for debate. What is less obvious, however, is how to confront these challenges.


While some of the issues are reliant on public solutions that don’t appear to be imminent, there are in fact several things that the private sector can do — and that the public sector can avoid doing — to make the most of 2019 open enrollment.

First of all, helping people get coverage is essential. Employers, for one, have a strong platform from which they can communicate to individuals who need health insurance. What’s more, this aids their own bottom line—while greatly helping employees.

Advocacy groups focused on increasing coverage overall (and public health coverage in particular) can recognize the platform that companies have and also work to make the most of it — even if it means making a compromise or two that would benefit the greater good (read: more covered Americans).

And while private insurance companies indisputably have a personal stake in seeing to it that more Americans are covered, the fact remains that doing so really will help the market. More covered lives on ACA-subsidized plans means a larger, healthier risk pool. A larger risk pool means more predictability for insurers. More predictability for insurers means more stability in the market. This leads to potentially more competition, which leads to more competitive pricing. Less of all of these things means more of what we’ve seen for several years now: chaos.

The best course of action of Congress, meanwhile, is to simply stop trying to pass legislation this year. This might seem counterintuitive, yet at this point any action at the federal level would throw planning for 2019 into turmoil. To avoid last year’s multiple late-stage changes, Congress should now focus on other priorities and shift back to healthcare reform and the individual market again after the midterms.

Also critical is allowing rules to normalize from state to state, since states are able to move more quickly to adjust to the lack of federal support. Yet allowing waivers at this point is a grand experiment with very few positives. Therefore it is preferable to limit the acceptance of (and calls for) waiver ideas as a show of good faith to consumers.

Finally — and perhaps most critically — is the prioritization of improving  the consumer experience. The fact remains that everyone,across the aisle, is ultimately working to help consumers. Despite disagreements about how or by whom individuals should be covered, few will challenge the fact that having everyone covered is good for both the economy and individuals.

That’s why it’s important to remember, whether we’re talking about an ACA-subsidized plan or an “alternative insurance arrangement,” consumers need to know what they’re getting and if it addresses their needs. Given the many frustrations that consumers have expressed in describing their enrollment experience this past year, this will be an even heavier lift and an essential one.

The challenges that lay ahead for the individual market are both broad and deep. But there are ways that these challenges can be addressed and for the negative ramifications to be, to an extent, alleviated. Better communication about available options, better explanation of the benefits and costs of those options and ultimately better overall support, will prove to be crucial prescriptions for a healthier individual market, both literally and figuratively.

George Kalogeropoulos is the CEO and co-founder of HealthSherpa. Shandon Fowler is the owner and principal of Four8 Insights.

Tags ACA Donald Trump Health care health plans Lamar Alexander Susan Collins

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