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.

Ana Kasparian, host for The Young Turks network, and John Phillips of The Orange County Register, CNN, and KABC discuss the end of cost-sharing reduction subsidies by the government.

KELLY MCEVERS, HOST:

To talk more about the politics of health care, I am joined here in the studio by Ana Kasparian. She’s co-host and producer for the online news network The Young Turks. Welcome.

ANA KASPARIAN: Thank you for having me.

MCEVERS: And John Phillips, political commentator for CNN and a columnist for the Orange County Register, welcome to you.

JOHN PHILLIPS: Thank you so much.

MCEVERS: So as we just heard, President Trump says one by one, his administration is dismantling the Affordable Care Act. But there is lots of polling to suggest that people do not want these insurance markets to fall apart. Some senators led by Republican Lamar Alexander of Tennessee had been working on a bipartisan bill to stabilize the markets, and now this. John, I’ll start with you. I mean, how is this move going to affect the president’s relationship with members of his own party?

PHILLIPS: Well, I think if you’re talking about voters who you first mentioned, people first vote with their feet before they vote at the ballot box. And one of the things the critics have been saying is if you allow people to leave the health exchange, if you allow people to leave Obamacare, anyone who can leave will leave. Well, what does that tell you about the product? I mean, that’s like the same argument that the teachers unions make about school vouchers and charter schools.

So I think that him making this move – and look; I’m a process guy, and I’d rather have Congress do it. But John McCain’s feelings are hurt, and he doesn’t have the votes right now. So he’s got to wait until Joe Manchin switches teams or Bob Menendez goes to prison. This was the best of a lot of bad options that he had, and kicking it to Congress is the long-term solution that I think is best for the Republicans and for Donald Trump.

MCEVERS: But is it going to work? I mean, Ana, these are – you know, as we just heard in Tam’s piece, President Trump needs votes on other things – the Iran deal, immigration, a tax bill among other things. Is, you know – are they going to be able to handle this stuff?

KASPARIAN: Well, whether or not Congress is going to be able to handle it is an interesting question. But what I do disagree with is the notion that Trump will allow Congress to do what it needs to do. I mean, he has already shown, and he is continuing to threaten Congress with unilateral action if they don’t give him exactly what he wants, which I think is fascinating given the fact that someone like Obama was criticized pretty aggressively by Republicans for signing executive orders and doing things unilaterally. So I do agree in our system of government and the need for checks and balances, especially when you have an individual which in my belief is as unhinged as Trump and doesn’t really understand the ramifications of these issues.

And just to quickly, you know, respond to your answer about voters, you know, when you do look at polling and you refer to the Affordable Care Act as the Affordable Care Act rather than Obamacare, even Republican voters like it, and it’s because it has provided certain protections for them that they don’t want to lose.

And I will not sit here and say that the Affordable Care Act is perfect. It was deeply flawed, and it did not have the proper cost controls in place to prevent higher premiums. But what Trump just did will increase premiums so much that, you know, Americans are really going to suffer. And I’m concerned about that.

MCEVERS: I mean, Republicans ran on promises to repeal Obamacare, and they didn’t have the votes to do it, as we know, in Congress. And now the president is acting on his own to hollow it out. Will this hurt Republican members of Congress in re-election races in 2018, John?

PHILLIPS: In the long term, getting a bill done is more important for Republicans in Congress than it is for Donald Trump. Donald Trump’s signature issue in the campaign was immigration. It was building the wall. If he doesn’t build the wall, his re-election chances have, you know, gone down to zero.

Republicans have won – what? – three different national elections based on repealing and replacing Obamacare. If Trump doesn’t get it done, it’s like going to Red Lobster and saying the chicken stinks. No one goes to Red Lobster for the chicken. They go there for the lobster. He’s selling immigration. They’re selling health care. If they don’t get it done, that’s a big blow to the Republicans in Congress.

MCEVERS: It sounds like he knows that, right?

PHILLIPS: Yes.

MCEVERS: (Laughter) I want to talk about the Democrats, too. I mean, this morning the president tweeted that now the Democrats have to call him to fix health care. I mean, is that true? Do they need to come to him at this point, Ana?

KASPARIAN: I don’t think they need to come to him. I think that that is a mistake because one thing that Donald Trump claims is that he’s a good negotiator. He has no interest in negotiations. He has all the interest in coercing or being coercive and threatening and bullying people into giving him what he wants. That is not a good negotiator.

What I would argue is that Democrats need to focus on their messaging because they are devastatingly weak in explaining and expressing how disastrous this will be for the American people. I mean, Republicans will latch onto something, and they will not let it go – Hillary Clinton with Benghazi. I mean, we’re still hearing about Benghazi. But Democrats – they – they’re soft, and they need to toughen up. And they need to really work on their messaging.

PHILLIPS: And for Democrats, it’s weird because Hillary Clinton won the nomination. She won the election over Bernie Sanders. But if you look Democratic voters are on issues like health care, Democratic voters are closer to Bernie Sanders…

KASPARIAN: Absolutely.

PHILLIPS: …Than they are to Hillary Clinton. So with all the problems that you see right now in Congress with Republicans, Democrats are facing the same issue. You saw Bernie Sanders standing up on stage with any number of Democrats who could be candidates for president next time around who signed on for single payer. Well, what is Nancy Pelosi going to do? What is Chuck Schumer going to do? What’s going to happen in Democratic primaries in the midterm elections, and what does that mean for compromise? It means compromise is probably not an option between the parties.

MCEVERS: Right. That leads to my next question. I mean, do you – either of you see any chance of some bipartisan solution to health care right now?

KASPARIAN: Quite honestly, I don’t because what I’m seeing is, you know, two or three senators – Republican senators that seem reasonable, and they’re looking out for the best interest of their constituents – Lisa Murkowski, Susan Collins and John McCain. But at the same time, you have some like Rand Paul that think, no, no, I want to get rid of everything. I don’t want to help Americans out at all.

And so there’s a disagreement within the Republican Party. There’s a lot of disagreement among Democrats. I feel like, you know, we need to figure out what’s going on in these two teams and kind of come to some sort of agreement before this negotiation could even happen.

MCEVERS: Likely?

PHILLIPS: I don’t think there’s any negotiation that can be done with the leadership with the Democratic Party. I think you could potentially pick off one or two votes. He could get a Joe Manchin to sign on. He could get a Heidi Heitkamp to sign on. And that way, you can lose a John McCain. You can lose a Susan Collins. But if you largely keep that Republican caucus together, one or two Democrats could put you over the top.

MCEVERS: Some people say that this fight could go to the states. Attorneys general in, you know, majority Democratic states here in California and New York have said they will sue the Trump administration to continue making these subsidy payments. Does that seem like a viable option going forward in the short term for the ACA?

KASPARIAN: I think it’s a viable option. I would like them to be more aggressive. Lawmakers in California squashed any and all efforts to provide universal health care to Californians, something that polls as very popular. And it kind of shows you where their heart is. And I just don’t agree with it.

MCEVERS: Ana Kasparian of The Young Turks and John Phillips, commentator for CNN and columnist for the Orange County Register, thanks to both of you.

PHILLIPS: Thank you.

KASPARIAN: 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.

NPR’S Robert Siegel talks with Sabrina Corlette, a professor at Georgetown University and expert on the health insurance market, about President Trump’s executive order on health associations and the impact they will have on the health care system.

ROBERT SIEGEL, HOST:

Now we turn to Sabrina Corlette. She used to be a staffer with the Senate Health Committee. She now studies the health insurance industry at Georgetown University. Welcome to the program.

SABRINA CORLETTE: Thank you.

SIEGEL: One of the things this executive order does is allow small businesses to band together with an association so they can get more coverage and cheaper coverage for their employees. What’s the problem with that?

CORLETTE: Well, there’s a couple of problems. One is that the Affordable Care Act is very clear that if you have a older or sicker group of employees, insurance companies can’t discriminate against you. This would turn that on its head. And if you came into the association with, say, somebody who had cancer or women of childbearing age, you could find that your premiums would be much, much higher than employers with healthier workers.

SIEGEL: But the difference would be that the associations would not be regulated, would not be covered by the requirements of the Affordable Care Act.

CORLETTE: That’s right. That’s right. The associations would be exempt from a lot of the insurance protections that are in the ACA.

SIEGEL: But as I understand it, health insurance policies that we get from our employers are also not directly covered in that sense. If everybody got a job at a company that gave them insurance, would that pose the same problem?

CORLETTE: Well, I think it’s important to distinguish between the kind of insurance you get at a large employer and what you might get through these association health plans. Remember that a large employer like NPR has both healthy and not-so-healthy employees, but the reason you have insurance is not ’cause you need insurance. It’s because you work at NPR.

Association health plans are different. The reason people are coming to them is because they need insurance. And so insurance companies are trying to protect themselves from people who need to use a lot of health care services.

SIEGEL: So the members of the association are individuals, or they’re groups of employees at companies who – what’s the association an association of?

CORLETTE: Well, here it sounds like what this executive order is directed at is associations that are made up of small employers. So you could imagine the Bar Association might have a group of law firms signing up for health insurance or the gym owners association. So there are multiple reasons why you could create an association, but essentially people would be using it to purchase insurance for their employees.

SIEGEL: But I mean, I’m sure you can appreciate what sounds like the appeal of this, which is that 20 law firms joining together to buy health insurance sounds like it’d get a better deal than each law firm individually trying to do that.

CORLETTE: Well, you’ll get a better deal if you have young, healthy workers. If you have older, sicker workers, you will be charged a higher premium to reflect the higher use of health care services.

SIEGEL: As we’ve mentioned, 150 million of us I think get health insurance through our employer. Are we affected by this executive order?

CORLETTE: Well, it’s hard to say. If these association health plans do become more widespread and are – become exempt from state laws, we could be, particularly if we work for a small employer. If, for example, we have a problem with our plan and we’re in one of these associations, we may not be able to get help from our state insurance department – for example, if claims aren’t being paid.

SIEGEL: What do you say to the argument that proposal like the one that’s made today with these new rules shouldn’t be compared with the ideal but rather with the real situation that many people face, which is the only policies they can afford and, under the Affordable Care Act, have such high deductibles that they feel they have no access to the real coverage? There’s a serious problem out there.

CORLETTE: There’s no question that the Affordable Care Act could use some policy fixes, but these are not the policy fixes that we need. Rather than fixing the problems that do exist with the Affordable Care Act marketplaces and shoring up the coverage, this effectively undermines those marketplaces and makes the coverage that is available to people with pre-existing conditions much less stable and secure.

SIEGEL: Sabrina Corlette studies health insurance reform issues at Georgetown University. Thanks for talking with us.

CORLETTE: Thank you.

(SOUNDBITE OF RJD2’S “MONSTERS UNDER MY BED”)

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.

David Greene talks to Planned Parenthood President Cecile Richards, who has denounced the Trump administration’s rollback of the Affordable Care mandate to cover birth control.

DAVID GREENE, HOST:

And the Trump administration is making it easier for employers to opt out of covering birth control in their health insurance plans. The coverage was guaranteed under the Obama administration with the exception of employees at some religious organizations. Attorney General Jeff Sessions said the Trump administration is leading by example on religious liberty. But this was a troubling development for Planned Parenthood Federation of America. And its president Cecile Richards is on the line. Good morning.

CECILE RICHARDS: Good morning.

GREENE: Let me just talk through the impact of this. The Trump administration said Friday that 99 percent of women will still have the same access to birth control. And they said less affluent women can still get free or subsidized contraceptives through Medicaid and other programs. I mean, do you agree with those numbers. Or what’s your estimate for the number of women who might be affected by this?

RICHARDS: Well, David, I mean, it’s incredibly ironic that they would now refer to programs that they’ve been trying to end through Trumpcare for the last, you know, several months – access to, you know, Planned Parenthood, access to Medicaid and access to the Family Planning Program. And the basic fact here is that millions and millions of women – now about 62 million women – have access to birth control and their insurance plan at no cost. And it’s led to amazing successes. Women have saved a lot of money. The estimates are 1.4 billion dollars alone the first year. We’ve reduced unintended pregnancy – the lowest rate of teen pregnancy in the history of the United States. And women are getting better birth control. All of these are good things. They allow women to plan their families and stay in the workforce. And this decision is basically now going to turn the reins over to your boss to decide whether or not women can get birth control. And that’s just not going to be good for women.

GREENE: But do you expect a lot of bosses to actually change that much? I mean, the Trump ministration is saying that this, in terms of numbers, is probably going to have very little impact. I mean, do you accept that?

RICHARDS: Well, one, I don’t think they – they don’t – certainly don’t know. And in fact, I mean, all of the things that they have put out are messages that send – that basically say birth control is dangerous for women, which is really crazy. More than 90 percent of women in this country use birth control for a whole host of reasons. I think the problem is, you know, we fought so hard under Obamacare to get women equal access to health care, including family planning. Because until that bill passed, many, many employers did not provide birth control for women. And again, women are now half the workforce in this country. And a big reason that we’ve been able to participate and work and go to school is because we’ve been able to plan our families. And that’s really what’s at risk here. And frankly, the Trump administration has been on a war against birth control and women’s health from day one.

GREENE: You feel like they’re sending a message that birth control can be dangerous because it seems the message they’re sending to some is that this is a matter of religious liberty and employers not being forced to, you know, sacrifice their religious beliefs.

RICHARDS: Well, I mean, that’s not – this is not what that rule says. The rule basically says if any employee or objects to birth control, they don’t have to provide it. And look. I think the problem is – you look who’s been in charge of Health and Human Services with the Trump administration. It has been filled with key positions, folks who have been against birth control from the very beginning. In fact, ironically, the woman who was appointed to run the National Family Planning Program has said herself she doesn’t believe in birth control. This is just the beginning. And I think many of us expect this will not end here. There are rumors of all kinds of other ways in which they’re going to restrict birth control access. And I just don’t understand it. It’s good for women’s health. It’s good for the economy. And this kind of attack is something that you would have expected in the 1930s, not in 2017.

GREENE: And we just have a few seconds left. But I mean, the Obama administration issued this mandate to cover birth control. Religious organizations filed suit. The Supreme Court ruled that the government can’t force private companies, nonprofits to pay for birth control against their religious beliefs. Are you concerned that the law is on the administration’s side here?

RICHARDS: Well, I mean, obviously we’ll be challenging it along with the ACLU, and that’s really important. But there were all kinds of accommodations made for a religious employer. The danger is you have things now like universities that provide birth control for women that are students. You have all kinds of organizations who may have their own political or religious views. Why should they be able to impose that on American women? It’s simply not right. And we’ll be fighting it every step of the way and ensuring that women continue to get birth control at Planned Parenthood.

GREENE: Cecile Richards is the president of Planned Parenthood Federation of America. We appreciate your time this morning. Thanks a lot.

RICHARDS: Good to see you, David. Thanks.

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.

NPR’s Robert Siegel talks with reporter Katie Thomas of The New York Times about how Hurricane Maria may cause shortages of essential drugs due to idled factories.

ROBERT SIEGEL, HOST:

When Hurricane Maria crashed into Puerto Rico, it dealt a powerful blow to the pharmaceutical industry. The island is an important exporter of drugs. Pharmaceuticals are a $15 billion business there. And that includes some medicines that are produced only in Puerto Rico, which raises the prospect of shortages here on the mainland. Reporter Katie Thomas wrote about this in The New York Times, and she joins us from Chicago. Welcome to the program.

KATIE THOMAS: Thank you.

SIEGEL: Put the Puerto Rican pharmaceutical industry in some perspective. How does it rank as a drug producer?

THOMAS: Well, it’s one of the top drug producers in the world. Drug companies and device manufacturers started building plants there decades ago thanks to tax breaks and plentiful available – of skilled labor there.

SIEGEL: You wrote this week that there are 80 pharmaceutical factories in Puerto Rico. Do we know how many of them are up and running at this stage?

THOMAS: We don’t. And I should say that those are a mix of factories. They’re pharmaceutical products. They’re also medical device makers and medical supply manufacturers. And we don’t have an exact tally, at least not one that’s being released. But several of the companies have told me that they’re either not back up and running, or they’re just barely starting to get into limited production.

SIEGEL: What kinds of problems are those people experiencing in Puerto Rico? What have they told you about?

THOMAS: Well, there’s been a host of problems. The biggest one is actually just getting employees to come in to work. These residents have lost their homes. They’re still struggling with many of their basic needs.

The second obstacle is electricity. You know, most of these plants are running on diesel generators. And while the companies say that they’re pretty comfortable and – with the fact that those are up and running and they’re working, there’s questions about how long they will last. If this is a long-term problem, and if it goes on for months, you know, will they run out of diesel fuel? Will the generators start breaking down? So that’s also a big concern.

SIEGEL: What are some of the drugs that are produced in Puerto Rico and, for that matter, only produced in Puerto Rico?

THOMAS: So the first thing I’ll say is that companies generally don’t give a list of which drugs and products they make in certain factories. And that’s been a problem for people in the U.S. and around the world in hospitals who are tracking this and anticipating shortages and trying to plan for it.

So we don’t know who makes these products exclusively in Puerto Rico. But some of the biggest drugs that are manufactured there – although they could be manufactured elsewhere as well – include Humira, which is the world’s top-selling drug, Xarelto, which is a blood thinner that prevents strokes. Even Tylenol is made in Puerto Rico.

SIEGEL: As you’ve said, Puerto Rico is also a place where many medical devices are made. What are you hearing about that?

THOMAS: So the device industry is just as concerned as the pharmaceutical industry is. And I heard today that if conditions continue as they are and they don’t measurably improve, they’re worried that there are some products there that could eventually go into shortage as quickly as three to seven weeks from now. One specific example that I was given was catheters for trauma surgery.

SIEGEL: Well, if, say, production of Humira, which is a rheumatoid arthritis drug – if it were interrupted in Puerto Rico, are pharmaceutical companies equipped to shift production to another place? Do we know if they’re that nimble?

THOMAS: So publicly they say that they are. And in their statements to us, they’ve been putting the most positive spin possible on this. They are mindful of their investors, and this is a very delicate situation for them. But we know that the FDA commissioner, Scott Gottlieb, has testified this week that he’s very concerned about potential critical shortages. He said that there are 40 drugs that are made by 10 firms that they’re closely watching. He didn’t list which drugs those were specifically, but it’s something that everyone is keeping a close eye on.

SIEGEL: That’s Katie Thomas, who covers the health care industry for The New York Times. Thanks for talking with us.

THOMAS: 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.