Congress will consider increasing its oversight of not-for-profit health insurance co-ops to boost the remaining coverage plans created under the Affordable Care Act.
Republicans will hold two congressional hearings this week to examine the recent wave of co-op closures. To date, 10 of the original 23 health plan co-ops have said they will close.
Kelly Crowe, CEO of the National Alliance of State Health Co-ops, said earlier this month that many of the closing co-ops were on the path to financial stability but could not weather the lack of federal financial support. The CMS will pay only 13% of the money insurers had requested from the risk-corridors program, which was designed to help companies offset losses from higher-than-expected claims with the help of companies that received fewer claims than expected. Last year, companies paid back $362 million, but requested $2.87 billion. Congress also is expected to take up the question of what will happen if a co-op plan cannot repay its federal loans.
The Office of Inspector General released a report in July that found 21 of the health plan co-ops experienced net losses. Most did not meet their initial enrollment and profitability projections at the end of 2014.
“With HHS already issuing lower ACA enrollment projections and health insurance giants merging to further limit competition, the presence of co-ops is needed now more than ever,” Crowe said. “Though federal regulators have taken some modest steps to ease co-ops' short-term financial burdens, a firmer commitment to fulfill the obligations of the ACA's risk programs is needed to provide stability to the marketplaces.”
Witnesses have yet to be named for the hearings, which will be held by the Ways and Means Subcommittee on Health and the Energy & Commerce Subcommittee on Oversight and Investigations.