Loss of Exchanges Would Complicate Health Insurers' Strategies
"If we go back to a state-by-state model with one state demanding this kind of coverage and another demanding something else, it's just going to become that much more complicated for the health insurers. The ACA simplified things in many ways."
For better or worse, the ACA took a lot of control and decision making away from the health plans, De La Torre notes. It specified essential health benefits, cost structures, and medical loss ratios under which all plans had to operate.
More Complicated, More Expensive, and More Risky
"You just had to price those products the best you could, in order to be competitive," he says. "Now if we're going back to the pre-2010 model, they're going to have to be everything to everyone. That's more complicated, more expensive, and more risky."
Insurers are developing a range of strategies for every foreseeable scenario, De La Torre says, but volume is the most difficult variable to nail down.
"It's hard to anticipate volume until you know the specifics of what changes are happening," he says.
"I serve on the board of the largest public health plan in America, and we can't anticipate the numbers because there are too many moving parts to anticipate how many people we are going to lose. But we can anticipate some of the impact in terms of how we provide the services, an 'if A, then B' approach, so that's where the focus is now."