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Senate Bill Could Push Plans More to Employer, Medicare Market

Analysis  |  By Gregory A. Freeman  
   July 12, 2017

Health plans may focus more on employer coverage and Medicare Advantage as they wait out healthcare reform efforts. The current Senate bill could hold some benefits for them, however.

Uncertainty over healthcare reform has created considerable challenges for health plans participating in Medicaid and the exchanges, leading many large national plans to focus on the two markets that appear to be insulated from the healthcare reform debate: employer coverage and Medicare Advantage, says one analyst.

Health plans considering exchange participation are submitting proposed rates and making participation decisions without knowing whether cost-sharing reductions will be paid or whether healthcare reform will put exchanges on a path toward being phased out, says Jeremy Earl, JD, partner and healthcare analyst with the law firm of McDermott Will & Emery in Washington, DC.

Some deadlines have passed already and insurers will have little flexibility no matter what happens with the Senate Republicans' healthcare reform bill, he says.

Some large plans are moving more to employer coverage and Medicare Advantage as a sort of safe harbor, letting the debate continue over Medicaid and the state exchanges while they work in the areas least affected by the controversy, he says.

Related: Sicker, Older, and More Likely To Drop Medicare Advantage Plans

The potential effect on health plans is split according to their business models, he explains. Plans that are heavily invested in the Medicaid managed care business model are likely to experience setbacks if the bill passes, Earl says, because over time the population on Medicaid would be reduced.

There also is the potential for some health plans to benefit from passage of the Senate bill, he says.

"If it does pass, the funding for cost-sharing reductions for 2018 and 2019 is one of the big goals for plans that have already committed to the exchanges for those years," he says.


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Gregory A. Freeman is a contributing writer for HealthLeaders.

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