美国国家公共电台 NPR Health Insurers Say They Don't Want To Go Back To Being The Bad Guys（在线收听）

AUDIE CORNISH, HOST:

President Trump and other Republican leaders are working furiously to repeal and replace the Affordable Care Act. Millions of Americans who have health insurance through the Obamacare marketplaces are wondering what will happen to them. Also scratching their collective heads - insurance companies. The Urban Institute and the Robert Wood Johnson Foundation recently interviewed executives at 13 insurers to get their perspectives at this moment of uncertainty.

Sabrina Corlette of Georgetown University was one of the researchers, and she joins us in studio. Hi there, Sabrina.

SABRINA CORLETTE: Hi, Audie.

CORNISH: You know, one thing you noted in your report was that in some ways the insurers were caught off guard by the election and election results, which surprised me because the problems (laughter) in the Affordable Care Act have been in the making for a while.

CORLETTE: I think many insurers were preparing for Hillary Clinton to win the election and expecting that if there were changes to the Affordable Care Act, they would be fairly modest. And so we were surprised as well in that the number of executives we spoke to that were sort of scrambling to figure out what their options were in this new policy environment.

CORNISH: All right. So in your research, you are making these phone calls to insurance executives, and you're asking them, OK, how worried are you about this repeal idea this year? What kinds of things do they say to you?

CORLETTE: Well, the first thing to know about insurers is they're not monolithic. They're coming from very different places. We talked to large national carriers. We talked to for-profits and nonprofits. We talked to local community-based provider-led plans. They really are coming at this from different perspectives. Some are very, very committed to staying in the market and serving this population. Others - not so sure about it.

But across the board, all of them said we cannot tolerate uncertainty. And so there comes a certain point when you just can't price your product high enough to account for the uncertain environment that they're in.

CORNISH: And they start making those decisions this year for next year.

CORLETTE: Exactly. They have to make these decisions right now because they're putting together their products and everything else for the review process, which starts in May. And my guess is when those plans and rates come out in May, we're going to see some pretty big price hikes because the uncertainty that they're feeling in the policy world from Congress and the White House is going to play out into the premiums that people will ultimately pay.

CORNISH: There's lots of ideas floating around about how a repeal or how a replacement should work. Did you hear insurance executives talking about specific provisions that they think need to go or stay that they were worried about?

CORLETTE: Well, one thing we heard over and over again was the need to maintain some form of incentive for healthy people to sign up for coverage. Of course, the Obamacare approach has been a penalty for people who don't enroll, which has been very controversial. Insurance companies will tell you they don't think it was a strong enough incentive. But they feel like that needs to stay, or it needs to be replaced with something at least as strong in terms of incentive to get healthy people to sign up.

CORNISH: Do you get the sense from insurers that they want things to be the way they were before the Affordable Care Act?

CORLETTE: No, not at all. I mean, if you remember before the Affordable Care Act, insurance companies were in many ways sort of, you know, the bad guy, right? People didn't like them because they were denying coverage to sick people, and they were charging them more and denying care.

Now I think their public image has improved because everybody gets covered even if you have a preexisting condition. So I don't think they want to go back to the days when they were sort of the - considered the bad guys.

CORNISH: Right. Now Obamacare itself is the bad guy - right? - ironically.

CORLETTE: (Laughter) Right. So I don't think they want to go back to that. On the other hand, I don't think they feel that Obamacare was a perfect law by any means. They've found plenty to criticize in it. So I - my sense is that they would rather see improvements to the basic structure of the law rather than starting back from scratch.

CORNISH: Sabrina Corlette is a professor at the center on health insurance reforms at Georgetown University. Thank you so much for speaking with us.

CORLETTE: Thank you, Audie.