As lawmakers and policy groups debated the mechanics of what would become the Affordable Care Act, health insurers saw the writing on the wall.
The public viewed as intolerable insurance strategies that denied coverage to people with pre-existing conditions or charged higher premiums to sick members. More people needed access to care, and that meant the system had to expand coverage and rewrite the rules.
America's Health Insurance Plans, then led by Karen Ignagni, supported some of the Obama administration's goals.
“They wanted to be seen on the side of getting something done,” said Richard Kirsch, a senior fellow at the liberal Roosevelt Institute. But AHIP also quietly funded the anti-reform U.S. Chamber of Commerce, hedging that there was still a chance to hang onto those traditional business tactics, looser regulations and high-margin employer plans. Like any industry on the precipice of massive change, insurers craved survival.
Almost six years into the ACA and three open enrollments later, the health insurance industry still suffers from an identity crisis. Most insurers have embraced the law now that it has survived two major U.S. Supreme Court threats. The law has helped many insurers financially through the tacit encouragement of products such as high-deductible plans, although the exchange market is a work in progress. But many are still trying to figure out how to pivot beyond what was the core of their business for so long: employer-based plans and holding down medical claims.
Hospital consolidation also has raised alarms in the industry, with insurers arguing that larger health systems are jacking up prices at will. Many of those same systems are cutting out the insurer by starting their own health plans.
As a result, insurers are shifting their attention to taxpayer-funded coverage and finding ways to grow outside the bounds of traditional health plans, such as selling technology services. And AHIP is working to emphasize that the industry is creatively maneuvering into new lines of business. But these changes have also contributed to friction with some of the big for-profit players. Aetna and UnitedHealth Group recently ditched AHIP, deciding to fight political and business battles on their own.