NPR’s Scott Simon talks with Michael Neidorff, CEO of the health insurance company Centene Corporation, which has expanded coverage on the insurance marketplace even as other insurers have withdrawn.

SCOTT SIMON, HOST:

The debate over how to reform or repeal the Affordable Care Act might be stalled in Congress, but insurance companies are already making plans for 2018. Some insurance companies are pulling out of the Obamacare exchanges because of uncertainty about the federal government’s commitment. That means a number of so-called bare counties in Nevada, Indiana and Ohio could lose all of their marketplace plans next year. But other companies have found a way to expand coverage. Centene Corporation is one of them. Its CEO, Michael Neidorff, joins us now from St. Louis. Mr. Neidorff, thanks so much for being with us.

MICHAEL NEIDORFF: Thank you. It’s very nice to be with you.

SIMON: Do I get this right, your company has more than doubled in exchange customers in recent years?

NEIDORFF: Yes. We went from – in 2016, we had about 480,000 lives. And in ’17, we have 1.2 million at the beginning of the year.

SIMON: So what are you doing differently?

NEIDORFF: Well, I think we’re just doing our thing our way. We believe it’s a good program. We’re focused on our population, which is at the lower end of the socioeconomic scale. And it’s a matter of giving them access, having the proper networks and truly medically managing it in the most constructive way. We believe the highest quality is the most cost effective, and we’ve been doing that. And it’s working.

SIMON: But are you often alone in these areas? Are you often the only provider?

NEIDORFF: In some counties, we’re the only provider. And that’s fine because we want the very sick and the very well. We want that balanced book of business. So…

SIMON: Yeah.

NEIDORFF: …You know, being the only one does not bother us.

SIMON: Well, it’s very fine for you. But can you see where people might prefer to have more than one possibility for their health care coverage?

NEIDORFF: I am pleased when they have a choice. I can show you one county in Southern California where they have a choice. And we have 85 percent of the market, pushing 90 percent. So in fact, I like when they have a choice because it makes us look that much better.

SIMON: You, as we note, certainly seem to be doing well. But I gather you’ve said in interviews that the Senate’s health care overhaul is headed in the right direction.

NEIDORFF: Well, I felt that where they were – it needed some more tweaking. It was headed in the right direction, in the right place. And I think it’s now going to be very stalled. The parliamentarian ruled last night and was just studying all the things she said. But it’s just going to further complicate what they can get done.

SIMON: Yeah. What kind of tweaks do you think need to be made?

NEIDORFF: Oh, I was looking to put in a – what we had titled the copper plan. And this was where there was wellness, a higher deductible and then catastrophic care for the young, healthy people who tend not to buy insurance because they’re not going to need it.

SIMON: Yeah.

NEIDORFF: But when – if they had the right policy, I wanted to see reinsurance as opposed to high-risk pools. Reinsurance keeps the health plan involved on a – maybe an 80-20 basis. I’m getting a little technical on you.

SIMON: Yeah, I don’t understand reinsurance.

NEIDORFF: Well, reinsurance is where if a case goes over, let’s say, $100,000, there is a reinsurance pool within the state. They pick up 80 percent of the cost, but we still have 20 percent, which means we’ll continue to manage it. And it’s a way to handle catastrophic care without trying to rate everybody.

SIMON: Is it hard to do business, Mr. Neidorff, when you’re in your business, if – in the midst of all this uncertainty?

NEIDORFF: No, I don’t find it that way. We have taken the point of view that you make your decisions based on the facts as they are today, you know. If you do the what-ifs, you’re going to be like what Ansoff once said over in Amsterdam, analysis by paralysis, or, I should say, paralysis by analysis. And so what we do is we’re deciding, what do we have today? And we’re playing by those rules, and it’s working.

SIMON: Michael Neidorff is the CEO of the Centene insurance company. Mr. Neidorff, thank you very much for speaking with us, sir.

NEIDORFF: It was my pleasure. Thank you.

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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.

What options do Senate Republicans have left in their effort to undo the Affordable Care Act, which is also known as Obamacare? The stakes seem much bigger than just health care.

DAVID GREENE, HOST:

The only thing that appears certain in the Senate when it comes to health care is that there will be a vote next week. Senate Majority Leader Mitch McConnell made that clear after a senators-only lunch with President Trump at the White House.

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MITCH MCCONNELL: Well, it’s pretty obvious we’ve had difficulty in getting 50 votes to proceed. But what I want to disabuse any of you of is the notion that we will not have that vote next week.

GREENE: Some double negatives there, but it sounds like what McConnell is saying is that there will be some kind of vote next week. What will be voted on? Let’s ask NPR congressional correspondent Susan Davis, who has been covering this. Good morning, Sue.

SUSAN DAVIS, BYLINE: Hey, David.

GREENE: So what options are left for Mitch McConnell right now? What could they vote on?

DAVIS: There’s really three options on the table. And the first one, and the one that seems most likely at this stage, is failure. They still simply don’t seem to have the votes it takes to pass a piece of legislation. The two pieces of legislation on the table are one option that would essentially just repeal much of the Affordable Care Act in the short term and give Congress a two-year delay period to try and find something to come up with to replace it with. And then the other option is a repeal-and-replace companion, where they repeal much of the law and, at the same time, institute a new system for people to purchase insurance on the individual market.

GREENE: But this is very complicated – right? – because weren’t there senators who voted for just repeal a couple years ago but are now saying they don’t want to vote for just repeal? I mean, there’s a lot of nuance and complexity here.

DAVIS: Health care is complicated…

GREENE: (Laughter) To say the least.

DAVIS: …As our president once said. You’re absolutely right. You know, what gets some combination of moderate senators back on board is likely to knock a couple conservatives off the team and vice versa. So I think there is a deep amount of pessimism going into the vote next week, but I don’t think you can underestimate sort of the push party leaders and the White House are making to try and get there.

GREENE: What is the push? What is happening behind the scenes?

DAVIS: You know, at this stage, it’s really one-on-one meetings. We know that there’s an orbit of about four to six senators that are holdouts that have deep concerns about the bill. Vice President Mike Pence has been very personally involved, as has Seema Verma, who is the White House’s top Medicaid official. They’re trying to figure out what these senators’ concerns are and if there’s a way to get there. One option they’re looking at is putting more money back into the bill to fund Medicaid.

GREENE: Sue, the stakes here feel like they might be higher for this party than just about health care. I mean, is it a stretch to say this is sort of a pressure test on Republicans and their ability to govern?

DAVIS: That’s not a stretch at all. You know, Ted Cruz was on Fox News last night, and he talked about the stakes. And this is what he had to say.

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TED CRUZ: If we get this right – if we follow through on Obamacare repeal, it sets this up for this to be the most productive Congress in decades, whereas if we’re paralyzed, we could blow an historic opportunity. I don’t want us to blow this opportunity.

DAVIS: When he talks about blowing the opportunity, the concern I hear the most from Republicans on Capitol Hill is that if health care collapses – if they cannot deliver on what has been their signature campaign promise, the infighting and the bad blood that it will generate will make it almost impossible for Republicans to move forward on their other legislative priorities. That includes overhauling the tax code and that long-promised infrastructure bill that the president and Republicans and some Democrats in Congress say that they want the most.

GREENE: All at a time, of course, when Republicans have both the White House and Congress, so a lot of pressure on them to actually govern. NPR’s congressional correspondent Susan Davis in our studios this morning – Sue, thanks.

DAVIS: Thank you.

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.