HHS emphasizes ACA success stories at forum

The heads of HHS and CMS tried to project confidence to insurers about the Affordable Care Act’s health insurance marketplaces after some of the largest companies announced plans to scale back their exchange offerings or increase premiums for 2017.

Speaking at a Washington, D.C. forum to highlight successes within the marketplace, HHS Secretary Sylvia Burwell said the ACA has expanded health coverage and slowed the growth in costs, but also acknowledged the law caused drastic changes in how insurers operate.

“Just four years ago, this industry operated on a completely different business model,” Burwell said. “In the individual market before the Affordable Care Act, insurers competed in large part by finding the healthiest, cheapest consumers. That often meant shutting out the people who needed coverage the most—those with pre-existing conditions.”

Burwell said with the ACA’s coverage requirements, it’s now on insurers to compete based on “quality and cost-effectiveness,” a drastic shift she admitted hasn’t been easy.

“As with any new market, it takes time to adjust pricing and practices. And as in any new market, some participants are adapting faster than others,” Burwell said. “We know this process can be challenging, but I remain confident and excited about the benefits to consumers, insurers and our entire health care delivery system from a transparent market where issuers can compete based on value, and I’m even more confident today than I was even at the end of the third open enrollment.”

Burwell went on to emphasize changes in care spurred by the ACA, including moving toward value-based care, improving care delivery and increased use of data and analytics to inform clinical decisions.

She also said the department welcomes feedback from insurers and has acted on it, like the changes to risk adjustment and verification for mid-year enrollment announced earlier in June, while also promising HHS is trying to attract more young adults to the exchanges.

CMS acting administrator struck a similar tone with his remarks in the afternoon portion of the forum, saying regulators and insurers have to give the post-ACA industry time to mature.

“The marketplace is in the middle of its first phase: a five-year learning and implementation stage,” Slavitt said.

Before the forum began, Healthcare.gov CEO Kevin Counihan had previewed several of the success stories to be presented at the meeting, including:

• Aetna setting a goal to have 75 percent of spending go through value-based contracts by 2020
• Intermountain placing behavioral health specialists within primary care office, an effort its dubbed a “Total Accountable Care Organization.”
• Horizon Blue Cross Blue Shield using analytics to identify uninsured markets in New Jersey and inform a marketing campaign which drew in 22,000 new enrollees.

What wasn’t mentioned by the speakers was the ongoing fight between insurers and agencies over risk-corridor payments. Designed to mitigate insurer losses over the first few years of open enrollment, a lack of funding by Congress led HHS to only award 12.6 percent of what insurers had requested, leading to several lawsuits.

Gerald Kominski, PhD, director of the UCLA Center for Health Policy Research, recently told HealthExec he believes insurers’ exits from exchanges is designed to put political pressure on Congress to extend ACA subsidies that go directly to insurance companies.