Julie Allen, director of government relations at Drinker, Biddle and Reath in Washington, said that she was not surprised by the announcements and that it's smart for insurers to push out ahead of the unknown. She also said the provisions they chose are predictable.
“Some of these things are low-hanging fruit,” Allen said. “Some of the insurers were already covering young adults, so this is not earth-shattering,” she said. “There's a much better handle on the costs associated with these changes, so it's not going to make them unprofitable.”
Ron Pollack, executive director of consumer group Families USA, said he was “pleased” with some of the pledges, but said the actions are not enough.
“This is not even a third of a loaf,” Pollack said. “The key things that drive insecurity and lack of peace of mind for families—they are not fixing,” he said. The insurers are not, he said, pledging to make sure that children and adults are not denied coverage if they have pre-existing conditions, changing annual caps or committing to the law's medical-loss ratios.
Those provisions carry risks and costs.
“Adding dependents to age 26 doesn't have the same risk as pre-existing conditions for kids up to age 19,” said Joel Michaels, a partner with McDermott, Will and Emery in Washington. But some of these other conditions—such as pre-existing—if you're the only insurer doing that, it can be a disproportionate draw.”
In response to the criticisms, Ignagni described the central conflict of guaranteed issue, a practice that prevents insurers from denying coverage for any reason, such as pre-existing conditions.
“The only way to do that is to get everyone in the pool,” Ignagni said. “And the only way to do that is (with) some type of policy measure.” That is the intent of the law's individual mandate, a provision the court could rule unconstitutional, either voiding the entire law or leaving insurers with the same leaky pool unless Congress finds another way.