A new strategy is emerging in health care reform. After the U.S. Senate rejected a "skinny" repeal of the Affordable Care Act, President Donald Trump is now considering taking on health care companies and members of Congress when it comes to their own health.
The president tweeted, "If a new health care bill is not approved quickly, bailouts for insurance companies and bailouts for members of Congress will end very soon."
Insurance companies receive what are known as cost-sharing reductions to help low-income customers with out-of-pocket costs.
W. Stephen Love, president and CEO of the Dallas Fort Worth Hospital Council — which represents 90 hospitals in the region, explained the history behind this mechanism.
"We knew that many people would sign up that had not had good primary care. There were people that were going to have chronic illnesses that had, for lack of a better term, pent-up need. So, as a result, there was a payment mechanism to go to the insurance companies to help them cover these people and to have reasonable deductibles," Love said.
He explained what could happen without those payments to the insurance companies.
"If you do that, the insurance companies are going to have to make up that difference. I mean, they have to make up some kind of margin, so in all likelihood, they are going to raise the overall premiums yet again," he said.
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Love says all sides need to work together and put in needed corrections to the marketplace.
In response to the president's statements, a spokesperson for Blue Cross Blue Shield of Texas provided the following statement:
"Our rates are based on several factors, including escalating health care costs and the growing use of that care, anticipated local medical care costs, pharmaceutical cost and utilization, among other variables. Our product pricing also reflects uncertainty and the associated risks that exist within this marketplace, including uncertainty around issues like the continued funding of cost sharing reductions (CSRs) and mechanisms that encourage broad and continuous coverage. In order for us to be able to offer viable products for consumers in a responsible, sustainable way, our rates must be actuarially sound. That requires us to account for the real risks and considerations that currently exist in our markets.
"A significant portion of our rates account for that uncertainty. The continued funding of cost sharing reductions is one of those factors. We will continue to work with legislators, regulators and other stakeholders toward getting the necessary certainty around these issues."
