Top priority for insurers: Keep Obamacare’s coverage mandate and subsidies - Axios
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Top priority for insurers: Keep Obamacare’s coverage mandate and subsidies

Xizi Hua / Flickr Creative Commons

The Trump administration's highly anticipated Obamacare "market stabilization" regulation, which could come as soon as this week, may help insurers by tightening the enrollment rules. But that's not what's at the top of health insurers' wish list. They care a lot more about keeping the subsidies and individual mandate tax — and they want the taxes on them repealed permanently.

That was the message Blue Cross Blue Shield Association lobbyists presented at a meeting with White House and Department of Health and Human Services officials on Feb. 6. Documents housed at the White House's Office of Management and Budget reveal that the industry wants the feds to temporarily keep the individual mandate until high-risk pools are funded and there are new rules for covering people with pre-existing conditions.

They also want to repeal the Obamacare taxes and "do no harm by maintaining cost-sharing reductions." And they're reminding federal officials that the insurance industry needs to know what to expect by this spring.

The problem: Republicans have been hostile to the mandate and subsidies. They view the mandate as anathema to individual choice, and they prefer the subsidies to be tied to age instead of income. Republicans also are not fans of the cost-sharing subsidies for low-income people. Yet, insurers and actuaries know those components are needed and overshadow the other administrative fixes.

  • "Without the penalty, the underlying actuarial soundness of the exchanges would be in trouble," said John Baackes, CEO of L.A. Care Health Plan, a Medicaid-based plan that has about 25,000 exchange members.
  • "The cost-sharing reduction subsidies are a big deal, and if those weren't paid, that effect would swamp some of this other stuff," said Cori Uccello, senior health fellow at the American Academy of Actuaries.

So what is that other stuff that could change how insurers price their plans in 2018?

Age band rating: Obamacare says insurers can charge older people only three times as much as younger people. The proposal to increase that ratio to 3.49-to-1 is viewed as inconsequential to many insurers, not to mention legally questionable, and the industry favors a statutory change to 5-to-1. But that could have its own negative ripple effect. "You don't want to increase premiums so much so that the healthy older folks drop coverage or don't enroll," Uccello said.

Special enrollment periods: The government has already tinkered with limiting how and when people can enroll for coverage outside of open enrollment, but the biggest insurers want a complete clamp-down on those exceptions. However, any changes to special enrollment periods "may give some who qualify pause to apply…which may further unbalance the risk pools," said Margaret Murray, CEO of the Association for Community Affiliated Plans.

Nonpayment of premiums: Obamacare enrollees have 90 days to pay overdue premiums before insurers can end their coverage. Baackes said he would want a compromise of that grace period to be 60 days.

And more: The Blue Cross Blue Shield Association also said it wants states, not the federal government, to handle reviews of health insurance rates and benefits; the continuation of so-called "grandmothered" and "grandfathered" plans; and the elimination of the federal small business exchanges, among other items.

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Trump: I didn't mention Israel while sharing intel with Russia

Evan Vucci / AP

President Trump met with Israeli Prime Minister Benjamin Netanyahu for a photo opportunity this morning, where he held the press pool back to refute last week's reports that he disclosed sensitive Israeli intelligence on ISIS to Russian officials in the Oval Office.

I never mentioned the word or the name Israel during that conversation. They're all saying I did, so you have another story wrong. Never mentioned the word Israel.

Okay, but... the initial reporting from May 15 on Trump's conversation with the Russians never claimed that he mentioned Israel at all, only that he disclosed information given to the United States by a key ally — which was reported to be Israel the next day — that was not intended to be shared. And of course, National Security Advisor H.R. McMaster said last week that Trump "wasn't even aware of where that information came from."

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Big business to Trump: Don't gut the State Department

Jacquelyn Martin / AP

Ahead of the White House's budget proposal this week, which is rumored to cut 31% from the budgets of State Department and USAID, hundreds of top business leaders have sent Secretary of State Rex Tillerson a letter urging him to fight for funding for State, per the WSJ.

A key quote: "With 95 percent of the world's consumers outside the United States and many of the fastest growing economies in the developing world, now is the time to double down on America's global economic leadership."

A taste of the signatories: Top executives from Walmart, Pfizer, Coca-Cola, GE, Nike, UPS, and Marriott.

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House and Trump administration to delay insurer subsidy case

(Atef Safadi / EPA Pool via AP)

The House and the Trump administration will seek an additional 90 days to resolve a pending court case over the legality of Affordable Care Act insurer subsidies, the Washington Examiner and CNBC report.

While the subsidies may continue to flow to plans operating on exchanges, the failure to reach a decision doesn't give insurers the certainty they're looking for. Plans must decide whether to participate in federal exchanges by June 21. If they don't get a guarantee that they'll keep receiving the subsidies, plans will likely drastically raise premiums or pull out of exchanges.

The Examiner reports the House and the White House are working on a plan to ensure the subsidies continue going to insurers, who pass them on to low-income enrollees.

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Supreme Court strikes down North Carolina redistricting

Jon Elswick / AP

The Supreme Court ruled Monday that North Carolina Republicans placed too many African-Americans in two congressional voting districts it re-mapped after the 2010 Census, according to the Associated Press.

Why it matters: The 5-3 ruling upholds a federal district court decision that argued North Carolina lawmakers packed more African American residents into the districts than was necessary, which was challenged by the state. But even with the new lines, Republicans continue to hold 10 of the state's 13 districts.

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Pittsburgh sours on Uber's driverless car experiment

Gene J. Puskar / AP

Nine months after Uber rolled out its self-driving car trials in Pittsburgh, the relationship is deteriorating, the New York Times reports.

Why it matters: Self-driving car companies are forming partnerships with cities that will allow them to test their vehicles on their streets. It's a high-risk, high-reward proposition for city leaders.

Pittsburgh Mayor Bill Peduto told The Washington Post this fall, "Is there going to be an accident in a robot car? Yes there is. But the greater goal is to make our streets safer in the long term. We have to start at some point and we can't wait for regulation to catch up with innovation."

The city's complaints: Uber began charging for rides that were expected to be free; it withdrew support from Pittsburgh's application for a major federal grant to overhaul transportation; and it hasn't hired local workers as it promised.

Uber's response: "Uber is proud to have put Pittsburgh on the self-driving map, an effort that included creating hundreds of tech jobs and investing hundreds of millions of dollars," Uber told the Times in a statement. "We hope to continue to have a positive presence in Pittsburgh by supporting the local economy and community."

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Another U.S. chemicals giant strikes global merger

Huntsman Corp. of Texas and Switzerland's Clariant have agreed to an all-stock merger that would create a specialty chemicals giant valued at around $20 billion (including debt). Clariant shareholders would hold around a 52% stake in the combined company, which is expected to generate $13.2 billion in annual sales and $2.3 billion of EBITDA.

Why it's a big deal: This tie-up is part of a trend of cross-border consolidation in the mega-chemicals space, following the pending deal between Praxair (Connecticut) and Linde (Germany) and PPG Industries (Pittsburgh) attempting to purchase Dutch rival Akzo Nobel. It's also notable for private equity buffs (yes, such people exist), as Huntsman was at the center of what arguably was the most contentious M&A failure failure of the financial crisis era.

Fun fact: "Huntsman... is best known for inventing the clam-shell styrofoam box for McDonald's Big Mac burgers." ― Reuters

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Report: Michael Flynn will plead 5th, decline subpoena

Saul Loeb / Pool Photo via AP

The Associated Press is reporting that Michael Flynn, the former general fired from his National Security Advisor role by President Trump for lying about his contacts with Russians, will decline a subpoena from the Senate Intelligence Committee.

  • The sourcing: "[A] person with direct knowledge of the matter... spoke on condition of anonymity to discuss the private interactions between Flynn and the committee."
  • Why this was coming: "Legal experts have said Flynn was unlikely to turn over the personal documents without immunity because he would be waiving some of his constitutional protections by doing so. Flynn has previously sought immunity from "unfair prosecution" to cooperate with the committee."

Background on the subpoena, here.

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First-class travel, hotel suites: WHO spending under scrutiny

Raphael Satter / AP

The World Health Organization nearly spent more on travel for its 7,000 staffers in 2016 — $201 million — than its combined programs for AIDS, hepatitis, malaria, tuberculosis, mental health, and substance abuse, which total $213.5 million, per the AP.

  • How it happened: Lax rules surrounding first-class travel and hotel bookings allowed WHO employees to ignore official travel policy. For example, the agency's Ebola head spent nearly $400,000 in West Africa during the crisis, often opting for helicopter travel.
  • Comparisons: Doctors Without Borders spent $43 million on travel for its 37,000 aid workers; UNICEF spent $140 million for its 13,000 staffers.
  • Worth noting: The agency's polio expenditures hit $450 million last year.
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Zuckerberg: I'm not using this trip to run for office

Jeff Chiu / AP

Facebook CEO Mark Zuckerberg announced in a Facebook post Sunday:

"Some of you have asked if this challenge means I'm running for public office. I'm not. I'm doing it to get a broader perspective to make sure we're best serving our community of almost 2 billion people at Facebook and doing the best work to promote equal opportunity at the Chan Zuckerberg Initiative."

His learned insight: Zuckerberg said he sees an opportunity for Facebook to connect users beyond people they already know, and is hoping to soon introduce a system that recommends "people you should know," like mentors and people outside of your social circle who can provide "a source of support and inspiration."

Read next: Inside Zuck's real political strategy

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Ford replaces CEO Mark Fields with autonomous driving exec

Carlos Osorio / AP

Ford will announce Monday morning that it is replacing CEO Mark Fields with Jim Hackett, who ran Steelcase furniture for 20 years before joining the car company, reports The New York Times. Hackett most recently headed Ford's autonomous vehicle subsidy, known as Ford Smart Mobility.

Under Fields, who served as CEO for three years, Ford shares dropped 40 percent. He also was criticized by investors and the board for failing to make Ford a competitive player in the development of high-tech vehicles for the future.

Between the lines: The shake-up shows that Ford is shifting its focus to accelerate its self-driving technology. As the NYT points out, Ford has lagged behind other large automakers like General Motors and tech companies like Google, both of which have already begun testing their own autonomous vehicles. Ford is promising it will have a fully operating driverless car on the road by 2021.