President Obama's meeting this week with insurance executives was either a pep talk or a desperate plea for them to hang on and not let his signature project fail.
President Obama's meeting this week with insurance executives shows that he understands that Obamacare is on loose footing.
The question now is whether President Obama has lost the faith of both insurers and consumers.
The president dropped in on a meeting between White House officials and executives from several leading health insurance companies Monday.
The meeting included leaders from Humana, Cigna, Highmark Health, Molina Healthcare and several Blue Cross Blue Shield insurers, along with Secretary of Health and Human Services Sylvia Burwell and senior adviser Valerie Jarrett, according to a statement from the White House.
The commander in chief also sent the companies a letter outlining what the administration is going to do next year to help them survive what is turning out to be a daunting insurance market for them and their customers.
In addition, Obama sent letters to each insurer offering exchange plans for 2017, saying he wanted to "underscore the importance of continuing the work that has helped bring the uninsured rate to the lowest level on record."
And he said he was seeking ideas on how to strengthen the marketplace. The letter sought to "emphasize the Administration's commitment to working with them, discuss recent actions to further strengthen the marketplace, and ask for their help in signing up uninsured Americans," a White House statement said.
"We know that this progress has not been without challenges," Obama said in the letter. "Most new enterprises have growing pains and opportunities for improvement. The marketplace, while strong, is no exception. Time and experience will help drive that improvement, as well constructive policy changes."
A Call for Radical Revision
Those "constructive policy changes" were not specified, but Obamacare needs radical revision and not just tinkering around the edges, says Elaina George, MD, an otolaryngologist in Atlanta and a member of the Project 21 leadership network at The National Center for Public Policy research. Small changes also are unlikely to improve the plight of consumers, she says.
"The projection is that it's going to get worse," she says. "Patients will have increasingly higher out-of-pocket costs and the insurance companies will continue to ratchet down what they consider to be medically necessary. Coverage options will drop, and physicians are leaving the insurance market and going to direct pay practices."
George points out that insurance companies are struggling in part because the administration did not follow through on one of its promises to them. When first crafted, the Patient Protection and Affordable Care Act had a provision for paying insurers if they could not get enough participants or could not stay profitable, he says.
"There was this pot of money they were supposed to be able to access, to make them whole," George says. "That was reneged on by the government and that's why we're seeing the exodus of the insurance companies, because they're not getting a bailout."
George also speculates that the biggest insurers are tempering their support for Obamacare because the Department of Justice filed lawsuits to block the merger deals between Aetna and Humana and Anthem and Cigna.
Anthem, Aetna Merger Suits Separated by Judge
She believes the real solution for both insurers and consumers is to move away from Obamacare and toward healthcare that is not hospital-based, with an emphasis on transparency in costs. Freestanding surgical centers and other options that don't involve checking into a hospital should be the way of the future, she says.
So far Obamacare has caused a consolidation and centralization of healthcare, which is exactly the opposite of what needs to happen, George says.
"A lot of damage has been done in the healthcare system by consolidation," George says.
"I don't think government is the answer. I think that as long as we're allowed to have a separate free market system, with transparency, people will start realizing these other options exist and start to put pressure on the system."
Gregory A. Freeman is a contributing writer for HealthLeaders.