October 14, 2017

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What Affordable Care Act Rollback Means For The Health Care Insurance Industry

Health insurance providers have already raised rates in anticipation of reduced government subsidies. NPR’s Michel Martin talks with health policy analyst Robert Laszewski about how the industry might fare.

MICHEL MARTIN, HOST:

We have one more conversation about healthcare. As we just heard, health insurers are trying to figure out what to do without the reimbursement from the government that the Trump administration says will no longer be paid. The question is, will insurers raise their rates or withdraw from the health exchanges created by the Affordable Care Act? For perspective on this, we called Robert Laszewski. He’s a former insurance executive who’s now a health policy consultant. Mr. Laszewski, thanks so much for speaking with us.

ROBERT LASZEWSKI: You’re welcome.

MARTIN: So based on your knowledge of the industry, what are the options that insurers are considering to deal with the lack of these subsidies?

LASZEWSKI: Well, actually, many of them have already raised the rates. They had to have their 2018 rates into the regulators and approved a couple of weeks ago, so most of them have already made some pretty significant rate increases – between 10 and 20 percent – assuming that Trump would cut off the subsidies. A few insurance companies and a few regulators did not do that. They did not allow for it. I think now what’s going to have to happen is these insurance companies today are having some pretty tense conversations with the regulators, saying, if you want us to stay in the market, you’re going to have to let us raise those rates 10 to 20 percent.

MARTIN: Is it possible or likely that some of these companies will just pull out? And can they do that even if they’ve already offered plans for the coming year?

LASZEWSKI: It is still possible for insurance companies to pull out. The contracts they have with the government have an out clause if there’s a major material change. So it’s possible. More likely, I think you’re going to see some regulators make some accommodations and allow for the higher rates to happen pretty quickly. I don’t think we’re going to see many, if any, pull-outs. Now we’ve got dozens of insurance companies involved, so I wouldn’t be shocked to see one do it. But generally speaking. The carriers have known this is coming, they know what kind of environment they’re in, and they’re pretty much pricing for it.

MARTIN: Let’s say for the sake of argument that companies do pull out of the exchange. Is there a tipping point at which the Affordable Care Act no longer effectively exists?

LASZEWSKI: Well, that’s possible if you had substantial carriers pull out in some of the larger markets – with any markets of any consequence with no insurance company. But I think we’re actually entering a strange period here. The insurance companies are figuring out how to make money in the Obamacare insurance exchanges. They just raise the rates. So the carriers – the insurance companies – are backing into a survivable market here. Run the rates up as high as you have to. They can at least break even. It becomes sustainable for the insurance company, but it’s a terrible situation for people who don’t get subsidies and have to pay the full cost.

MARTIN: So finally, before we let you go, are there other options on the table? Could Congress theoretically, anyway, pass some sort of a patch to fund these cost savings reimbursement?

LASZEWSKI: Absolutely. The Congress could pass legislation not only to fix the cost-sharing subsidy problem that Trump created but to fix a lot of other problems. Obamacare has some very serious architectural problems when it comes to the insurance exchanges. It needs an overhaul minimally. So the Congress could fix it, but here’s the problem – Trump would veto it.

So I think we’re stuck in a really bizarre period right now, one where people getting subsidies are going to be OK. Even though we cut the funding to the insurance companies, they’re going to get their subsidies to help pay for it. But 43 percent of those in the individual market didn’t get a subsidy last year because they made too much money, and those people are really getting hurt.

MARTIN: That’s Robert Laszewski. He’s a health policy consultant, a former insurance executive. He was kind enough to speak to us by phone just outside Washington, D.C. Mr. Laszewski, thanks so much for speaking with us.

LASZEWSKI: You’re welcome.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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What Affordable Care Act Rollback Means For The Health Care Insurance Industry

Health insurance providers have already raised rates in anticipation of reduced government subsidies. NPR’s Michel Martin talks with health policy analyst Robert Laszewski about how the industry might fare.

MICHEL MARTIN, HOST:

We have one more conversation about healthcare. As we just heard, health insurers are trying to figure out what to do without the reimbursement from the government that the Trump administration says will no longer be paid. The question is, will insurers raise their rates or withdraw from the health exchanges created by the Affordable Care Act? For perspective on this, we called Robert Laszewski. He’s a former insurance executive who’s now a health policy consultant. Mr. Laszewski, thanks so much for speaking with us.

ROBERT LASZEWSKI: You’re welcome.

MARTIN: So based on your knowledge of the industry, what are the options that insurers are considering to deal with the lack of these subsidies?

LASZEWSKI: Well, actually, many of them have already raised the rates. They had to have their 2018 rates into the regulators and approved a couple of weeks ago, so most of them have already made some pretty significant rate increases – between 10 and 20 percent – assuming that Trump would cut off the subsidies. A few insurance companies and a few regulators did not do that. They did not allow for it. I think now what’s going to have to happen is these insurance companies today are having some pretty tense conversations with the regulators, saying, if you want us to stay in the market, you’re going to have to let us raise those rates 10 to 20 percent.

MARTIN: Is it possible or likely that some of these companies will just pull out? And can they do that even if they’ve already offered plans for the coming year?

LASZEWSKI: It is still possible for insurance companies to pull out. The contracts they have with the government have an out clause if there’s a major material change. So it’s possible. More likely, I think you’re going to see some regulators make some accommodations and allow for the higher rates to happen pretty quickly. I don’t think we’re going to see many, if any, pull-outs. Now we’ve got dozens of insurance companies involved, so I wouldn’t be shocked to see one do it. But generally speaking. The carriers have known this is coming, they know what kind of environment they’re in, and they’re pretty much pricing for it.

MARTIN: Let’s say for the sake of argument that companies do pull out of the exchange. Is there a tipping point at which the Affordable Care Act no longer effectively exists?

LASZEWSKI: Well, that’s possible if you had substantial carriers pull out in some of the larger markets – with any markets of any consequence with no insurance company. But I think we’re actually entering a strange period here. The insurance companies are figuring out how to make money in the Obamacare insurance exchanges. They just raise the rates. So the carriers – the insurance companies – are backing into a survivable market here. Run the rates up as high as you have to. They can at least break even. It becomes sustainable for the insurance company, but it’s a terrible situation for people who don’t get subsidies and have to pay the full cost.

MARTIN: So finally, before we let you go, are there other options on the table? Could Congress theoretically, anyway, pass some sort of a patch to fund these cost savings reimbursement?

LASZEWSKI: Absolutely. The Congress could pass legislation not only to fix the cost-sharing subsidy problem that Trump created but to fix a lot of other problems. Obamacare has some very serious architectural problems when it comes to the insurance exchanges. It needs an overhaul minimally. So the Congress could fix it, but here’s the problem – Trump would veto it.

So I think we’re stuck in a really bizarre period right now, one where people getting subsidies are going to be OK. Even though we cut the funding to the insurance companies, they’re going to get their subsidies to help pay for it. But 43 percent of those in the individual market didn’t get a subsidy last year because they made too much money, and those people are really getting hurt.

MARTIN: That’s Robert Laszewski. He’s a health policy consultant, a former insurance executive. He was kind enough to speak to us by phone just outside Washington, D.C. Mr. Laszewski, thanks so much for speaking with us.

LASZEWSKI: You’re welcome.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Barbershop: U.S. Men's Soccer Loss, Boy Scouts And Eminem

The U.S. men’s soccer team failed to qualify for the World Cup, the Boy Scouts are letting girls join their ranks and Eminem has a bone to pick with the president. CNN’s AJ Willingham, The Guardian‘s Les Carpenter and columnist Gustavo Arellano discuss.

MICHEL MARTIN, HOST:

Now it’s time for the Barbershop. That’s where we gather interesting folks to talk about what’s in the news and what’s on their minds. Sitting in the chairs for a shapeup today are Les Carpenter. He is a writer for The Guardian, and he’s with us from our studios in Washington, D.C. Les, welcome. Thanks for joining us.

LES CARPENTER: Welcome. Thank you.

MARTIN: All right. Also with us, writer and journalist Gustavo Arellano. He’s known for his nationally syndicated column “Ask A Mexican” and his book “Taco Usa: How Mexican Food Conquered America.” He’s with us from KUCI in Irvine, Calif. Gustavo, welcome back.

GUSTAVO ARELLANO: Hola, Michel.

MARTIN: And welcome back to CNN writer AJ Willingham, who joins us from WCLK in Atlanta. AJ, good to have you back with us as well.

AJ WILLINGHAM: Good afternoon, Michel.

MARTIN: So let’s start the conversation today with what is an open wound for American soccer fans. For the first time since 1986, the U.S. men’s soccer team failed to qualify for the World Cup. They lost 2-1 to Trinidad and Tobago, a team that many felt they could handle. On Friday, U.S. coach Bruce Arena announced his resignation. And…

(SOUNDBITE OF ARCHIVED RECORDING)

BRUCE ARENA: It’s a blemish for us. We should not be staying home for this World Cup.

MARTIN: AJ, I’m going to start with you because you focus on sports. What happened here? And I also want to mention that he said also in the same press conference that there was no need for a lot to change. So what happened, and is he right, does nothing need to change?

WILLINGHAM: I think it really depends on what sort of scale we’re looking at. We’re really talking about a matter of scale. What happened is, you know, if Clint Dempsey’s goal had gone in, we would have been going to Russia, but it didn’t. Is that where the conversation stops? Obviously not. Nothing has to change, now, in retrospect, feels like sort of the wrong thing to say. I think that that’s, you know, quite clear that that’s not the case. But what I think happened here is that there is just a lack of passion, both in playing and a lack of an understanding, that if we didn’t make the World Cup, that it would be such a huge deal and such a national embarrassment and such a wake-up call to, you know, to what soccer looks like at a national level for us to what it looks like to viewers and to potential fans and just all up and down the line. And really, I mean, choose where you want to come in on this because, like I said, it’s a matter of inches or it’s a matter of hundreds and thousands of viewers.

MARTIN: So, Les, you wrote – you’ve gotten a lot of attention for a story that you wrote last year on American soccer’s diversity problem. I mean, your piece argued that soccer in the U.S., unlike the rest of the world, is kind of a white upper-class-suburban sport. And that kind of hurts the – it just hurts the sort of the pool of players, the talent that would be available. You want to talk a little bit more about that?

CARPENTER: Well, it not only hurts the pool of players, it also hurts the idea of a culture, which is what I think U.S. Soccer really needs to be looking at right now. It’s not such a matter of, oh, we’re just a couple inches away against Trinidad and Tobago. We could have just gone to another World Cup. It’s a matter of, what kind of style does the U.S. play? Who is us trying to be? And I think that soccer’s played great by Latinos who have come to this country and a lot of places that don’t have access to what’s become a pay-for-play system in this country. You have so many of these leagues right now where if you’re rich, you have a lot of money, you can get on a team. And if you’re halfway good, you have a good chance of getting to a big college, getting seen by the national team people.

But what happens to all these people that have come from Guatemala, Honduras, Mexico, where the kids, you know, from those families are playing just on the streets? They don’t have access to the system, and yet, their style is so free, and it’s what’s played around the rest of the world. The U.S. is very robotic. And I feel like what we see now, the culture and the style and the U.S. is Americanized. We’ve taken soccer and just coached it coached and coached it, so you don’t really have that free kind of open style that you have elsewhere, and it’s starting to hurt at this level.

MARTIN: OK. But let me just raise one issue here, which is that you look at the U.S. women’s gymnastics team that competed so successfully at the last Olympics, 3 of the 5 people on that team were girls of color. It’s an extremely expensive sport. So what is the deal with that? You know, these are also people who, you know, Gabby Douglas made no secret of the fact that this was tremendously costly to her family, but somehow she was able to get there. So what’s the difference, you know what I mean?

CARPENTER: Well, obviously, it’s – even for wealthy families, these things are going to be extremely expensive.

MARTIN: She’s not wealthy.

CARPENTER: But, I mean, there’s – the action – the commitment has been there from her parents. I mean, you’re talking in many cases with soccer about people who have come to this country with nothing or people who have almost nothing and their kids are wonderful, wonderful players, but they can’t get into that system. It’s a big – obviously, you’re looking at a much bigger pool – in gymnastics where you’re – it’s a tiny group of players – athletes. With soccer, it’s a massive, massive group. And yet, these kids don’t have a shot at even just the basic level of organized soccer that gets you seen to that level where Gabby Douglas is training in a high level play for the U.S. Olympic team. You don’t have the access to be seen in this country at that level.

MARTIN: Gustavo, what do you think?

ARELLANO: First and foremost, respect to all the Trinnies (ph) out there for their amazing victory over the U.S.

MARTIN: True that.

ARELLANO: I had a huge bowl of callaloo in their honor, so God bless them for that. I agreed with everything that Les said. I mean, this is what it boils down to. Why should – I mean, we have immigrant populations who are crazy about soccer, that are playing on the field at parks all across the United States from New York City down here to Santa Ana in Orange County. They’re playing all the time. And they’re playing in leagues. They are playing in their own leagues that are way cheaper than whatever leagues you need to get into U.S. soccer. So the parents are going to say, well, why should my kids play in the expensive leagues when you could just play at the Saturday leagues?

More importantly though, a lot of – and this is a big problem that I think U.S. Soccer still has to solve and they can’t – a lot of these players, if they could get dual citizenship, if you ask your typical Mexican-American kid right now, if you want to be a great soccer player, would you play for the Mexican squad, El Tri, or are you going to play for the United States? Ninety percent of them would go to El Tri, not just out of loyalty but also because, frankly, El Tri’s going to be a better team than the U.S. But then, you know, and I also have to say, Mexicans are so happy that the United States is not going into the World Top. That said, us Mexicans, we have our own problems as well so we could be happy about that, but whatever. We’re going to flame out in the second round like we do every year or every Cup, I mean.

MARTIN: (Laughter) All right. Well, you know, let me just point out – AJ, let me go back to you on this – a lot of people were quick to point out that one American soccer team still has a shot to make their World Cup. The women’s team went undefeated in 2015 and won the World Cup. So, AJ, is there something that the men can learn from the women, or is the same problem going to catch up with them? Because it has not escaped, I think, anybody’s attention who’s paying attention that the women’s team isn’t particularly diverse either.

WILLINGHAM: What I’m thinking about this, Michel, what I’m thinking is you have to make good soccer in order for people to want to watch good soccer. And there are two things that you can do to make that happen. You either have to be successful, win your games, you know, get those goals in, or you have to be newsworthy. And I think that one thing the U.S. women’s national team has going for them is that they are both of those things. They’re successful, and they are newsworthy off the field. They, you know, they keep the names in the news.

I feel like if you asked a casual viewer who Alex Morgan was, asked a casual viewer who Clint Dempsey, was maybe they know both of them, but I feel like because of the U.S. women’s national team’s success, they know a little bit more about the women. They know a little bit more about what it means to, you know, to cheer for them and to root for them. And so to me, that’s the big sort of thing is that you’re winning games but then you’re keeping yourself in the news. You’re keeping yourself in the headlines, and you’re you’re keeping people’s interest. And I think that those two things feed off of each other.

MARTIN: Let me move to another topic this Wednesday. The Boy Scouts said that girls can now join. And some people were saying that’s cool girls can be Eagle Scouts now, and that’s nice. And for families who maybe have multiple kids, they think that’s great. I only have to go to one community center on the weekends and that’s good for me. But others are not happy including, Girl Scouts USA. And, AJ, sticking with you – sort of focusing on you today, sorry to be sort of giving you the burden of the whole thing, carrying the ball as it were – but you co-authored a piece on CNN this week highlighting some of the negative responses to this. And what’s your take on it?

WILLINGHAM: Yes. So obviously, the Girl Scouts are not going to be happy about this. I want to give them credit. They have certainly done a lot in the last couple of years to try and boost membership. It’s no secret that membership for both the gender scouting sort of organizations have been down over decades. It’s just, you know, it’s something that’s very difficult to modernize. So they have definitely done their part. They brought in consultants. They diversified their programs. But what they did is that they took away some of the attention from outdoor activities. They took away some of that attention from some of the more adventurous programs.

Like I said, it went to other things, but so the Boy Scouts, seeing their numbers go down and seeing their own numbers being hurt by some of the more recent scandals, thus is a perfect opportunity for them to come in. They have the outdoor stuff that a lot of young women are going to be interested in. And most importantly, they have the Eagle Scout designation. And that is something that the Girl Scouts have not been able to replicate, even though they have the wonderful Gold Award. In the culture – in our culture, it is not as prestigiously sort of looked at as that Eagle Scout award, and that is the big thing.

MARTIN: But, you know, Gustavo, do you want to talk about that for a second? You know, they – but the Girl Scouts have other things which is that they have a track record – it’s – an incredible number of women in high levels of achievement have been Girl Scouts. And I don’t know. What’s your take on this?

ARELLANO: Yeah, no, I love the Girl Scouts. You know…

MARTIN: The cookies especially.

ARELLANO: …I buy hundreds of dollars of cookies. And not just the cookies, they also have their nuts sale right now for the winter, so people should be buying those as well. But I have seen so many young women be transformed by the Girl Scouts. And I’ve seen like – they do – they’ve always been a far more progressive organization than the Boy Scouts. What amazes me most about this is how much the Boy Scouts has changed within a generation. About 25 years ago or so, there was a national story that came out of Orange County where there was two scouts who were atheist and they just – they would not say the Pledge of Allegiance or they wouldn’t say under God in the Pledge of Allegiance, so the Boy Scouts at the time booted them.

In a generation, now you’ve gone from such like backward opportunistic ways to the Boy Scouts saying, hey, like, let’s also include girls in there as well. And, of course, it’s all for money. It’s all for getting more membership in there. But yeah, I mean, people – the Girls Scouts is an amazing organization. They really focused on, yeah, let’s teach our young women out there of all colors, of, you know, of everything, let’s teach them skills that they’re going to go out and, you know, make better people in society. Nothing against the outdoors but camping, yeah, it’s nice but it’s not going to get you a job.

MARTIN: Les, what do you think about this?

CARPENTER: You know, I’m thinking about my 7-year-old daughter. She’s never gotten into scouting. Thank God we haven’t had to cross that bridge yet. But honestly, I think she’d be more interested in what the Boy Scouts offer than what the Girl Scouts offer.

MARTIN: Because?

CARPENTER: Because I think she’s that kind of a person. She’s very adventurous. She wants to try things. She’s the kind of girl who would, you know, see a gondola, you know, 20 feet up in the air and say, hey, I’d like to jump in that and see where it goes. I mean, so I think that what the Boy Scouts offer will be far more interesting to her than what the Girl Scouts offer. And I know it’s a massive generalization, but I think this is something that she would think was a lot of fun.

MARTIN: I’ll have to arrange an escort to get you out of the building because there are a lot of Girl Scout parents and Scout leaders in there. I’ll see what I can do.

WILLINGHAM: Michel.

MARTIN: Go ahead, AJ.

WILLINGHAM: Michel, I want to go really quickly back to the negative reaction.

MARTIN: Sure.

WILLINGHAM: Obviously, a lot of people on social media, a lot of people in the general conversation sort of, you know, thinking that this is going to somehow rend the gender binary because we’re going to have boys in the Girl Scouts and, you know, boys and girls, and they could just be anywhere together now. I think what people forget is that girls have been in Boy Scouting programs now for a century. You know, they allow girls in the venturing program. And so it’s really not – yes – is it a big move? Yes, but it’s not unprecedented in their history to have girls participate in their activities. I think people forget that.

MARTIN: I confess, I was one that forgot that, so thank you for bringing that up. Before we let you go, gosh, I only have a minute left. So, Gustavo, I’m going to go to you on this. Eminem – I think by now, people have heard about his kind of scathing rap about President Trump at the BET Awards earlier this week. And I wanted to ask you your take on that.

ARELLANO: I love it. I know people are criticizing it because he gets the attention, not other rappers of color. I’ll say what I said on Code Switch a couple of months ago. Sometimes you need those people to go out and to places or to people that don’t want to listen to your message. Eminem has a huge suburban white audience. These people worship him as a god. And for him to be saying all those things about our current president, it comes as a shock to them, but they listen to him. They would not listen to the people. So good job, Eminem.

MARTIN: Because you agree with him, but what if you didn’t? Would you be offended?

ARELLANO: If I – if he supported Trump?

MARTIN: Yeah.

ARELLANO: Oh, well, then I wouldn’t like him.

(LAUGHTER)

ARELLANO: I mean, I like Eminem. You know, I’m for any of these entertainers who take stands, whether they’re good or not, because they are risking their fans. I mean, look at what’s happening with the NFL, I mean, with (unintelligible) and everything like that. They are taking their stand. And according to some people – I don’t got the stats – but, you know, they’re losing fans and all that, but at least they’re taking that position though.

MARTIN: Oh, I hear. All right. Well, that’s your – thanks for your take on that. That’s Gustavo Arellano. He’s an author and nationally syndicated columnist. Les Carpenter is a writer for The Guardian. AJ Willingham is a writer for CNN. Thank you all so much for joining us.

CARPENTER: Thank you.

ARELLANO: Gracias.

WILLINGHAM: Thank you, Michel.

(SOUNDBITE OF EMINEM’S “THE REAL SLIM SHADY”)

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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