MH: How did this year's sign-up go?
Tavenner: Based on what I'm hearing from the plans, enrollment has been steady—at least equal to and in some cases more than last year. Some are doing better because other plans pulled out of the market. The auto-enrollment process sent some people to the plans that remained.
MH:What can consumers and firms expect in the employer-based market for 2018?
Tavenner: That's still where the bulk of the business is, 180 million people. We're seeing some pickup in medical costs. Pharma has definitely picked up, most of it in the specialty drug area. Our plans are seeing that pharma as a percent of the premium is approaching hospitalization—getting up closer to 20%. Even the CMS is seeing an uptick due to pharma.
MH: So will rates go up faster for employers?
Tavenner: I'm guessing, but maybe it will pick up by a half-percent or so. But in the ACA, we can't say because it will depend on what they do with the cost-sharing subsidies and the premium tax credit. No one can price until it's decided. That's why we're pushing for a decision. Time is of the essence.
MH: Most of the replacement plans floated in Congress involve relying on some form of high-deductible plans coupled with health savings accounts. Do you support that?
Tavenner: They've still not settled on a single plan or group of plans. Our team has spent a great deal of time with proposal after proposal. They're still seeking information. We want them to make the right decision. Having said that, HSAs will be part of their proposal. HSAs can serve an important purpose. We do not feel they're just for high-income folks. HSAs are in the Indiana Medicaid plan. It's a demo, but people are working with HSAs at lower income levels. We've worked closely with Chairman (Orrin) Hatch (of the Senate Finance Committee) prior to the election to make sure HSAs can serve a big role in the insurance market.
MH: Are you concerned about their impact on efforts to improve population health?
Tavenner: I don't know if I'm black or white on it. But if your first $5,000 in medical care is out of reach, that's not an ideal HSA. We have to start thinking about how we might want to use them today. Think about it. If you're in Medicare and you are high income, you are seeing your premiums go up more than you saw in the employer-sponsored market. HSAs, which can be given to your family members, can help with that. We have to begin thinking beyond the traditional HSA.In Indiana, the money funded by the state for Medicaid HSAs was about $600 or $1,000. It's a way to go. I think they can have a future.
MH: Did anybody from the Trump administration reach out to you?
Tavenner: We reached out to them. I have not met with them directly, but our team has.
MH: Given the political situation, do you foresee ACA plans continuing into 2018?
Tavenner: I hope so. More and more people are talking about making changes beyond 2019. There's an understanding that in order to price products for 2018 and get them out in the market, it will be very difficult to make changes this year. We need at least an 18-month window since plans should always start on Jan. 1. It's important for the consumer, and it's important for the plans.