Healthcare

Insurance lobby chief confronts storm over Medicare for All

At the first Democratic presidential debates last month, the threat to private health insurance was stark, with multiple leading  candidates indicating they would eliminate it entirely in their quest to provide universal health care.

It's Matt Eyles's job to make sure they don't.

As the head of the health insurance lobbying group America's Health Insurance Plans (AHIP), Eyles is helping lead the industry's fight against "Medicare for All," while pushing for more incremental changes, such as lowering prescription drug prices.

"Medicare for All, in my perspective, is really sort of the analog to repeal and replace," he told The Hill in an interview in his office overlooking Pennsylvania Avenue. "It sounds good as a slogan. It's really hard to do, and there's a lot of problems when you think about it."

But Eyles acknowledges that there is a growing wave of frustration at the health care system that is helping drive the calls for sweeping change.

2020 White House candidates such as Sens. Bernie Sanders (I-Vt.), Elizabeth Warren (D-Mass.) and Kamala Harris (D-Calif.) say that the roughly 30 million people who are still uninsured, as well as the millions more facing high costs even with insurance, point to the need to wipe away the current landscape of employer-sponsored private insurance in favor of a government-run system.

"We need to do a better job of educating people, to make sure that they understand what it is that we're doing," Eyles said, pointing to private insurers' efforts to keep people healthy and use new technology to improve care, including letting people consult doctors from afar.

The Medicare for All effort faces an enormous climb for Democrats, including the need to win the White House, the Senate and overcome doubts even among many party voters.

But it is fueled by personal stories like that of Ady Barkan, an advocate for Medicare for All who is dying of ALS.

"To every candidate who doesn't support #MedicareForAll: I had to sue my insurance company to cover my ventilator," he tweeted in June. "I pay $9,000 per month in medical bills. How will you fix that?"

Asked to respond, Eyles acknowledged "really, really challenging, difficult personal stories" but said Medicare for All is not the way to address them

"There are always sympathetic stories, and we want to make sure that people get the care that they need, but I think that going to the Medicare for All side isn't really going to lead to that better outcome," he said.

Insurers are issuing an array of warnings against Medicare for All, arguing the system would require the government to make decisions on which services to cover and could lead to longer wait times for care. Eyles added that private insurers are better suited to adopt new technologies and to implement programs to help keep patients healthy. He also says shifting the entire health care system to Medicare for All would be incredibly "disruptive."

"When you ask people about the industry, we can do better, when you ask people about their specific health plan, they typically like it and have very high approval ratings," Eyles said.

Health insurers are instead pushing for smaller changes including lowering drug prices and protecting patients from getting massive "surprise" medical bills from out-of-network doctors. The industry argues those are more pragmatic ways to address the public's concerns about affordability.

Eyles even opened the door to a larger role for the government in reducing drug prices, saying that the health insurance industry's opposition to the favored Democratic policy of Medicare negotiating drug prices might not extend to certain high-priced drugs that face no competition.

He said an idea that is the subject of talks between Speaker Nancy Pelosi (D-Calif.) and the White House - namely, a form of negotiation targeted at certain drugs - "has some promise."

"If there's competition out there in the market, our members do a really good job on negotiating," Eyles said. "It's really in those certain areas where there is no competition and there are no alternatives that I think we probably need to think a little bit differently about the role that the government would play."

And there is another threat hanging over the industry and health care system: a GOP-backed lawsuit seeking to overturn ObamaCare.  

Legal experts still think it is unlikely the challengers' arguments will ultimately succeed, but even the possibility has gotten AHIP's attention, and judges at the 5th Circuit Court of Appeals seemed favorable to the challengers at oral arguments last week.  

Eyles said "it would be traumatic for the health care system and enormously disruptive" if the Affordable Care Act were struck down.

"You don't want to overreact to any one piece, knowing that it's a long process, but certainly the nature of the discussion at the case and the line of questioning has to raise some concerns," Eyles said of the arguments last week.  

When not fighting these battles, Eyles spends time going to his son's sporting events and his daughter's theater performances. And he gets in some time for concerts himself, catching the Rolling Stones at FedEx Field earlier this month.

Before moving to health insurers, Eyles spent much of his career working on the other side, for pharmaceutical companies, inside knowledge he has used in his current job to argue that drug companies alone are responsible for how they set their high prices.

His first job, though, was not in industry but at the Congressional Budget Office. The very first paper he worked on there, in 1994, was analyzing a mandate to buy health insurance, something that decades later became a centerpiece of ObamaCare and the current lawsuit against it.

"It stayed relevant," Eyles said with a laugh.

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