The investor-service company gauges impact of new 'association' health plans, expanded short-term insurance, and elimination of subsidies on the Obamacare exchanges.
President Donald Trump's health-insurance executive actions last week are credit negative for insurance carriers operating on the Obamacare exchanges, New York, NY-based Moody's Investors Service reported today.
On Oct. 12, Trump took two executive actions that will likely undermine the insurance exchanges established under the Patient Protection and Affordable Care Act (PPACA), Moody's says:
- In an executive order, the president eased regulations on "association" health plans and expanded the definition of short-term health insurance. The executive order calls for the federal departments of Labor, Treasury and Health and Human Services to expand insurance coverage for individuals such as allowing insurance purchases across state lines.
- Although regulations must be put into place, association health plans will likely allow small businesses to band together to offer insurance to their employees. "Associations likely would be allowed to offer plans with lower benefits and lower costs," Moody's reported.
- In a decision that did not require an executive order, Trump announced that his administration would end cost-sharing reduction (CSR) payments that subsidize the purchase of health insurance on the exchanges. The subsidies help insure low-income individuals who do not qualify for Medicaid coverage but can't afford to buy commercial insurance health plans.
- This year, the federal government spent about $7 billion on CSR payments.
The executive order is expected to promote creation of skimpy health plans, which would undermine the PPACA exchanges, Moody's reported. "The introduction of lower-benefit, lower-cost plans and short-term insurance would be credit negative for health insurers that are still participating in the PPACA-governed individual market. These new plans would incentivize healthy people to exit the PPACA market, which would increase risk in the remaining pool of insureds."
The decision to stop CSR payments will also have a credit negative effect on commercial carriers operating on the exchanges, Moody's reported. This negative impact will fall particularly hard on commercial insurers that did not submit rates for next year based on the assumption that the CSR payments would be eliminated.
Health insurance rates are set on a state-by-state basis.
There could be an "offset" linked to the executive order that would soften the financial blow for commercial carriers operating on the exchanges, Moody's reported. "If the executive order succeeds in bringing more healthy but currently uninsured people into the small group or individual market, that could mitigate at least some of the order’s negative effects."
Moody's highlighted the PPACA-exchange risk exposure of four commercial carriers in today's report, which lists the companies' beneficiaries on the exchanges as a percentage of their total number of health-insurance beneficiaries:
- Indianapolis-based Anthem Inc.: 2.9%
- Chicago-based Health Care Service Corporation: 6.8%
- St. Louis-based Centene Corporation: 9.2%
- Long Beach, CA-based Molina Healthcare Inc.: 20.4%
Christopher Cheney is the senior clinical care editor at HealthLeaders.