State leaders are positioning themselves to have a key voice in a potential rewrite of ObamaCare next year.
With the election of Donald Trump, Republican leaders in Congress have promised a dramatic overhaul of President Obama’s signature policy.
The National Governors Association (NGA), a proudly bipartisan group representing every state, is now eyeing a more public — and more aggressive — role alongside GOP leaders as they attempt to gut the massive federal program.
“Governors will be very, very active and engaged,” the group’s health policy director Frederick Isasi said in an interview. “They really are one of the few groups who are, in this very tangible day-to-day way, are living the results of the policies.”
Governors from both parties will be on the front lines of healthcare reform next year. Many will be under intense pressure to avoid an abrupt repeal of law that would prompt 22 million people to lose their coverage and likely cause a marketplace crash.
Many state leaders, including insurance commissioners of both parties, say they are already anxious about the billions of dollars at stake in the fate of ObamaCare. That includes subsidies to help people buy insurance and the funding to help pay for Medicaid expansion, which would both be drained under the GOP's plan. It also includes millions in state grants for initiatives like public health and prevention programs.
Nick Gerhart, a Republican who is the state insurance commissioner in Iowa, warned this week that repealing ObamaCare without a replacement would have “devastating consequences.”
“The idea of folks having credible coverage today that is no longer there come June or July or some mid-point of the year, it really is going to be disruptive, not only to the insurance market but also to those peoples’ individual lives,” he wrote in an op-ed published Tuesday.
The NGA, which comprises a majority of GOP governors, is unlikely to stake out public positions on major parts of ObamaCare, like Medicaid, which remain controversial among its members.
The group generally only weighs in publicly when a policy has broad support or opposition across its members, such as funding to fight opioids or the Zika virus.
But input from the governors group is likely to carry weight at a table with GOP leaders in Congress and the White House. Governors from both parties are charged with ensuring the stability of their healthcare marketplaces and have a vested interest in preventing any sudden movements that could spook insurers.
Before this month's elections, state-level health leaders largely believed they had settled the biggest questions surrounding ObamaCare. States were most looking ahead to other issues, like the rising costs of prescription drugs and getting their state exchanges to be self-sustaining.
Now, governors and their state commissioners are facing a May 1 deadline to convince insurance companies to continue offering coverage in 2018. Most insurers make those decisions months ahead of time, shortening the timeline even further.
“It’s the health insurers I worry about,” Mike Kreidler, the insurance commissioner for Washington state, said last week. “Nothing mandates that they have to be in the marketplace. And there’s enough uncertainty, because of all the talk that’s taking place.”
Kreidler said he’s already worried about a crash in the individual marketplace if insurers pull out next year, and planned a meeting with three insurer CEOs immediately after the election. He added that he — and many insurance companies — are nervous about the lack of details from the GOP about how the party would replace ObamaCare.
“They’re talking about repealing in a vacuum. I think that is a guaranteed recipe for absolute uncertainty going forward,” Kreidler said.
Republican leaders, including House Speaker Paul RyanPaul Davis RyanPaul Ryan researched narcissistic personality disorder after Trump win: book Paul Ryan says it's 'really clear' Biden won election: 'It was not rigged. It was not stolen' Democrats fret over Trump-district retirements ahead of midterms MORE (R-Wis.) are rushing to send an ObamaCare repeal bill to incoming President TrumpDonald TrumpCapitol fencing starts coming down after 'Justice for J6' rally Netanyahu suggests Biden fell asleep in meeting with Israeli PM Aides try to keep Biden away from unscripted events or long interviews, book claims MORE within his first few months in office.
But Ryan, who has released a 37-page report on a potential replacement plan, has given no hints about when the full legislative text could be released or when the policies could go into effect.
One state health leader said he is not yet panicking because he believes Republicans will take two years “at the absolute minimum” to make any major changes to ObamaCares.
“You can’t whipsaw a part of this economy that dramatically this fast,” the state health leader said, citing the huge pressure from industry groups. “So, we can breathe deeply and not have knee-jerk reactions.”
The lack of certainty about the law's fate, however, could cause damage to the marketplace even before an official repeal bill reaches Trump's desk.
“Given the uncertainty, I honestly can’t fathom why any insurer would want to come forward and offer plans for 2018, without some guarantees that there’s going to be a balanced, viable market,” said Sabrina Corlette, a researcher with the Georgetown University Center on Health Insurance Reforms.
The National Association of Insurance Commissioners (NAIC), which represents health commissioners, hasn’t released a specific statement about how the election could reshape healthcare markets. The insurer lobbying group, America’s Health Insurance Plans, has also remained largely quiet post-election.
A spokesman for the NAIC said the group would have more to say about ObamaCare come next year, after the newly elected commissioners assume their roles.
He also acknowledged that the healthcare law has been in almost full effect for three years and in place for six — hinting at the need for incremental changes.
“The time to fix the law is long past due and state regulators have the experience and knowledge to assist the new president and Congress to make health insurance work for all Americans,” the NAIC spokesman wrote in a statement.
Peter Lee, a strong ObamaCare advocate and head of California’s state marketplace, said he believes GOP will have to accept that they cannot simply rip out the major pillars on ObamaCare.
He also cited Trump’s comments in the hours after his election, when he said he was considering keeping parts of the law, such as protections for people with preexisting conditions.
“I do take the president-elect at his word when he says he doesn’t want to leave people on the streets and he says there’s no repeal without replace,” Lee said in a recent interview. “It means there has to be a thoughtful and deliverable process.”