Influencing what "replace" looks like

President Donald Trump campaigned on a promise to repeal Obama’s national health care law on his first day in office. He and Republicans have not presented an agreed-upon replacement plan, but key issues they are expected to address include the law's requirements for individuals to have insurance.


Insurers' main “ask” takes into account replacement plans under discussion in Congress, and largely assumes that government funds will continue to subsidize health benefits, at least for the next two to three years.

Daniel Hilferty, CEO of Independence Blue Cross in Pennsylvania, told Reuters that he advocated tightening the rules around signing up for insurance outside of the open enrollment period, and tight control of which third parties are allowed to pay premiums for patients.

Independence is part of a nationwide network of Blue Cross Blue Shield licensees such as Anthem Inc., and has enrolled more than 300,000 consumers in individual plans.

Hilferty's requests, echoed by other people in the industry who did not want to be named, are similar to demands the industry made of Obama. Enrollment outside of the regular period - and third-party groups that keep poorer, sicker patients in the private market by paying their premiums - has helped lead to hundreds of millions of dollars in losses for insurers and pushed three of the nation’s largest players out of the Obamacare market.

In addition, Independence is also asking for a bigger role in signing up new customers who want to buy individual plans. Insurers sell plans both on the exchanges and off the exchanges, but subsidized plans are currently mostly sold on the government run HealthCare.gov and on state-run websites in a dozen states.

"It would be really helpful if we in the industry played a more significant role in the actual enrollment process," Hilferty said.

Trump signed an executive order on Friday directing the federal government to scale back regulations, taxes and penalties related to the law. But the directive did not change the priorities outlined to Reuters by the insurers and industry sources, they said.

Focus on the mandate, cost sharing

Insurers have built their list of top priorities assuming, in part, that Republicans will try to overturn the existing individual mandate, which requires Americans to pay a fee if they do not have insurance. A replacement plan would need to include some type of bonus to entice healthy people to get insurance.

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