Lobbyists for health insurance companies are telling Vermont lawmakers that the federal Affordable Care Act could be dismantled in pieces starting in the next few weeks.
At the same time, they agree that the law, also known as Obamacare, cannot be immediately replaced, and there is no one plan in Washington, D.C., that Republicans are standing behind.
The lobbyists made their comments at a Wednesday hearing of the House Health Care Committee on what steps the state should take to maintain affordable coverage for Vermonters if the health care law is gutted this year.
President Donald Trump campaigned on repealing the Affordable Care Act and has pushed Congress to replace the law at the same time it is repealed. He has since told national news outlets that replacement could take at least a year.
Republicans can use the reconciliation process to pass, using a simple majority, a bill to defund nearly $100 million in federal subsidies offered to customers on Vermont Health Connect and at least $269 million in funding for enrollees in Medicaid expansion.
But Margaret Laggis, the lobbyist for America’s Health Insurance Plans — the national trade association for health insurance companies — said any other legislation Congress passed to change insurance laws would not go into effect until at least 2019.
“We would like to believe that there is a plan, that somebody in Washington has a plan,” Laggis said. “It is currently our position that there is no plan — that there are a lot of people who don’t like the ACA that are in charge down there but that they really don’t have a plan.”
She said the trade association took the position after holding a conference call with stakeholders across the country Friday. “Even though people ran on, ‘We are going to repeal this and it’s going to be done and over with,’ we do not believe that the changes that even get made this year will likely affect insurance plans until most likely 2019.”
Rebecca Heintz, general counsel for Blue Cross Blue Shield of Vermont, said the provision in the ACA allowing young adults to sign up for their parents’ insurance through age 26 was not likely to be repealed because “everyone loves that” and “it doesn’t even have an impact on premiums.”
Susan Gretkowski, a lobbyist for MVP Health Care, a major insurer in Vermont and New York, said the company hired a lobbying firm in Washington to keep up to date on what is going on with the Affordable Care Act.
MVP controls about 10 percent of the market of individuals who use Vermont Health Connect, which was set up to comply with the Affordable Care Act. Blue Cross Blue Shield of Vermont has the other 90 percent.
“There will be a move to repeal the individual mandate within the next few weeks, and then whatever else is going to be repealed would be phased out over a two-year period,” Gretkowski said. “Everything else we hear about ‘replace’ is very jumbled.”
The individual mandate is the part of the Affordable Care Act that requires all Americans to have health insurance or pay a fine to the Internal Revenue Service. The mandate has been criticized since the Affordable Care Act passed, but it was upheld in a U.S. Supreme Court case in 2012.
Supporters of the mandate say it forces healthy people and young people to buy insurance, therefore spreading out the cost of sicker people’s health care among a larger insurance risk pool, and lowering health insurance premiums.
Gretkowski said there are already some young people choosing to pay the fine instead of buy health insurance. But if that penalty went away, she said, fewer healthy people would sign up for health insurance, so there would be “an upward impact on premiums.”
She said Vermont could help people afford their insurance by offering state-funded subsidies. The state could also keep premiums more stable by retaining the Obamacare policy of once-a-year open enrollment so that “people do not wait until they’re sick” to sign up for insurance, she said.
Al Gobeille, the secretary of the Agency of Human Services, told lawmakers his staff would work hard to protect Vermonters, echoing the position of the Scott administration to protect vulnerable people
“The problem with complicated things is that people get frustrated with them, and when they get frustrated with them — if you’ve ever tried to fix a weedwacker in your garage — you want to throw it away,” Gobeille said. “It is not easy to change law.”
He pointed to a rule from the U.S. Centers for Medicare and Medicaid Services, unrelated to potential Obamacare repeal, that will take until 2018 to implement because of laws guiding a federal rulemaking process.
“If you really want to change the Affordable Care Act, you’re really thinking 2020,” Gobeille said. “You just can’t make these moves in markets that quickly. If you remember when the Affordable Care Act passed, at the earliest part of President Obama’s presidency, it didn’t start until 2014.”
Nonetheless, lawmakers say they are concerned. And Laggis, from the health insurance association, also acknowledged that the concern is already widespread throughout her industry.
“We represent a lot of really big companies, and they are all very concerned about what is happening with the little man behind the curtain,” she said.
Rep. Bill Lippert, D-Hinesburg, the chair of the House Health Care Committee, replied: “Is there a curtain?”