New Hyde Park, N.Y.-based Northwell Health's CEO, Michael Dowling, told the New York Times that the GOP bill would drown hospitals that serve low-income patients. And Dr. J. Mario Molina, recently ousted as CEO of Medicaid insurer Molina Healthcare, criticized the legislation for threatening to raise premiums and further destabilize the individual insurance market.
But these candid executives are rarities. Elsewhere in the industry, it's crickets, despite warnings from health policy experts who say the AHCA could leave more than 20 million Americans without health insurance.
"There's been a lessening of CEOs speaking out who should be speaking out," said Bill George, a senior fellow at the Harvard Business School who was CEO of medical-device maker Medtronic from 1991 to 2001. "But I think (CEOs) have an obligation because it's going to have such a dramatic effect on everyone's business."
A spokeswoman for America's Health Insurance Plans, the insurance industry's largest lobbying group, said several health plans have provided their perspective on healthcare reform. But "what's more important is that health plans are speaking with one voice about how the AHCA would impact those who rely on Medicaid or the individual market for coverage, and the improvements we recommend."
It is possible CEOs have gone mum out of fear, George said. President Donald Trump sent the shares of Boeing and Lockheed Martin tumbling after criticizing the companies via Twitter.
"A lot of CEOs that I know are fearful of a Trump tweet," said George, who has served on the boards of companies including the Mayo Clinic and Novartis.
Molina told Modern Healthcare that his ousting from the company his father built could have a "chilling effect" on healthcare advocacy. The Trump administration and the Republican-controlled Congress have the power to disrupt healthcare companies' business models, and insurers are relying on taxpayer-funded government programs as an increasing portion of their revenue. Medicaid makes up 20% and Medicare Advantage accounts for 12% of insurers' total premium revenue in aggregate, according to ratings firm S&P Global.
The individual insurance market, on the other hand, represents a small slice of insurers' revenue—less than 10% of total premium revenue.
The stakes are high for health insurers and their patients. Insurers are busy determining individual insurance rates for 2018. In the five states that have published 2018 rates so far—Connecticut, Maryland, Oregon, Vermont and Virginia—and the District of Columbia, insurers consistently asked for double-digit rate hikes with some requests exceeding 50%.
Those 2018 rates could climb even higher if the federal government doesn't take steps to ease insurers' jitters over ACA repeal-and-replace efforts, insurers said.
"This is a very serious situation. Just as people are adjusting to the ACA, now we're going to have the AHCA, and (companies) don't know what's going to be in there," George said. "CEOs have to be engaged. I don't think they have a choice."