What Makes Health Insurers Nervous?

According to the Associated Press, that would be a Romney victory (http://m.apnews.com/ap/db_16029/contentdetail.htm?contentguid=Gxnr5xp1). Excerpts:

You'd think health insurance CEOs would be chilling the bubbly with Republican Mitt Romney's improved election prospects, but instead they're in a quandary.

Although the industry hates parts of President Barack Obama's health care law, major outfits such as UnitedHealth Group and BlueCross Blue Shield also stand to rake in billions of dollars from new customers who'll get health insurance under the law. The companies already have invested tens of millions to carry it out.

Were Romney elected, insurers would be in for months of uncertainty as his administration gets used to Washington and tries to make good on his promise repeal Obama's law. Simultaneously, federal and state bureaucrats and the health care industry would face a rush of legal deadlines for putting into place the major pieces of what Republicans deride as "Obamacare."

Would they follow the law on the books or the one in the works? What would federal courts tell them to do?

The answers probably would hinge on an always unwieldy Congress.

Things could get grim for the industry if Republicans succeed in repealing the Affordable Care Act's subsidies and mandates, but leave standing its requirement that insurers cover people with health problems. If that's the outcome, the industry fears people literally could get health insurance on the way to the emergency room, and that would drive up premiums.

Obama's law is starting to look more and more like a tangible business opportunity. In a little over a year, some 30 million uninsured people will start getting coverage through a mix of subsidized private insurance for middle-class households and expanded Medicaid for low-income people. Many of the new Medicaid recipients would get signed up in commercial managed care companies.

A recent PricewaterhouseCoopers study estimated the new markets would be worth $50 billion to $60 billion in premiums in 2014, and as much as $230 billion annually within seven years.

And. . .

NPR weighs in on whether Romney can actually do anything about ObamaCare (http://www.npr.org/2012/10/30/163929221/can-romney-really-repeal-obamaca...). Excerpts:

But there are two big questions in there. First of all, could a President Romney actually stop the health law in its tracks? And if he did try, what would happen?

First, it turns out that stopping the law may be harder than the law's opponents realize. For one thing, if he's elected, Romney can't just grant waivers letting states ignore the law on his first day as president.

In this case, the part of the law that allows the president to grant states waivers doesn't actually kick in until 2017. And even the waivers that are allowed require states to cover as many uninsured people as would be covered by the Affordable Care Act.

Health industry consultant Robert Laszewski – also no big fan of the law – says federal courts would likely block a lot of things Romney might try to do unilaterally, like simply cut off funding or tell his staff to stop enforcing it.

Which brings us to the repeal part of Romney's promise.

If Republicans gain control of Congress, they plan to use a fast-track procedure called budget reconciliation to repeal major chunks of the measure. That's because budget reconciliation can't be filibustered and needs only 51 Senate votes rather than the usual 60.

But there are a couple of problems with that, says Laszewski. One is that's more time-consuming than many people realize.

And there's still another complication. It turns out that not all of the law can be undone using the budget process. Things like requiring insurers to accept people with preexisting health conditions would almost certainly need the same 60 votes to undo as they needed to pass in the first place. Laszewski says that could cause problems of its own.

My comment:

Finally, someone has put a number on how much the insurance industry stands to gain through the mandate foisted on the American people by Congress through the so-called Affordable Care Act. Apparently, it will eventually be as much as $230 billion each year. The meager millions and billions of lobbying costs which created this law now sound like a very good investment. But, what if Romney wins and starts to unravel the law? Chaos, or so says NPR. But no one is counting the chaos of actually trying to implement a law that is creating an enormous public debt while at the same time undermining the care of American patients. Medicaid payments are already too low to sustain hospitals that are dependent on that program, and ObamaCare anticipates both increasing the number of people on Medicaid and reducing the reimbursement amounts even more. The health insurance Americans will be required to buy will have a lower actuarial value than has traditionally been the case, meaning that patients and their families will be at greater financial risk when illness and injury strikes, leading to more families bankrupted by medical care and doctors and hospitals going without payment, but still required to treat the sick and injured. Medicare payments will also be diluted as money originally destined for that program will be diverted to subsidize the purchase of subpar health insurance for those unable to qualify for Medicaid but also unable to afford the mandated insurance premium. The only winners here are the health insurers. And they have always been the problem in the 'unique' American health care delivery scheme. Business as usual in American health care ala ObamaCare is chaos for the American patient. A Romney victory looks like the best option we have to disrupt the doom hanging over American health care. To be sure, Romney is not proposing a sound fix for the problem. But if he stops ObamaCare and opens up options for real and comprehensive health system reform at the state level (where the process has always belonged anyway), then there is a way forward for all of us.

Dr. Joe Jarvis