HHS Secretary Alex Azar told a crowd of insurers on Thursday that the Trump administration will do what it can "within the law" to let insurers offer plans that go beyond what is allowed under the Affordable Care Act.
In his speech at a policy conference sponsored by America's Health Insurance Plans, the secretary also said the administration will intervene to perhaps an "uncomfortable degree" to drive price transparency and competition in healthcare as he urged insurers to do their part to tell patients what they are paying for procedures.
But he notably touched on the question of noncompliant plans, which has loomed large this week on Capitol Hill as lawmakers scramble to put together an individual market stabilization package that could pass with the spending omnibus. The White House injected new difficulty into the negotiations with the Tuesday release of a memo asking Congress for legislation to allow ongoing renewal of short-term plans.
Sen. John Barrasso (R-Wy.) followed up on the memo by introducing a bill that would allow auto-renewal—a move that has generated concerns among insurers on the individual market.
Azar reiterated on Thursday the Trump administration's stance on giving consumers options outside the ACA's coverage mandates.
"More broadly, we are committed to using the flexibilities we have within the law to allow insurers to offer competitive products that work for consumers," Azar said. "We know the layers of regulation imposed by the Affordable Care Act have made this almost impossible. Consistent with the law, we want to work with you to open up new affordable and flexible options."
Currently, states are pushing various options. Blue Cross of Idaho has unveiled five plans that don't comply with the ACA, which Azar has promised to consider with the caveat that he will follow current law.
On Wednesday, the Iowa Senate overwhelmingly passed a bill pushed by the Iowa Farm Bureau Federation that would allow the bureau to sell noncompliant health plans that would allow medical underwriting. These plans would be insured by the state's heavy-weight carrier, Wellmark Blue Cross and Blue Shield.
But the HHS secretary also vehemently criticized the system of hidden fees for hospital procedures, the lack of transparency of the rates negotiated between commercial insurers and providers as well as arbitrary markups for basic procedures.
Insurers and providers both need to be more transparent about costs at every level, he said, and urged them to play their part in telling consumers what their procedures will cost and lay out the various charges by hospitals and doctors.
"The good news is that some of you have taken steps in this direction already, and we applaud you for it," Azar told the AHIP audience. "Some insurers and employers have created tools that show people what different local providers charge for a procedure. The information is correctly 'grouped' together so you don't have to add together the doctor's charge, the hospital's charge and the cost of other services."
But Azar said he would also ease up on insurers on the regulatory front. "We know the amount of time and money that goes into complying with well-meaning but often byzantine rules and regulations regarding consumer communications."
The speech contained a veiled warning that the Trump administration won't be friendly to anti-competitive forces, although Azar did not directly address the hospital and insurer consolidation that shows no sign of abating.
Forthcoming federal intervention, Azar said, "may sound surprising coming from an administration that deeply believes in the power of markets and competition. But the status quo is far from a competitive free market in the economic sense of the term, and healthcare is such a complex system, that facilitating a competitive, value-based marketplace is going to be disruptive to existing actors."
AHIP President and CEO Marilyn Tavenner, who ran the CMS under President Barack Obama, praised the speech as a forecast of the association's goals moving forward.
In a statement, AHIP said insurers are working toward similar strategies including using technology to streamline healthcare processes for patients and pushing competition. On the question of pricing transparency, the group highlighted drug prices in particular, which Azar had also addressed.
"We agree the system today is fragmented," AHIP said. "That's why insurance providers are committed to working together to simplify healthcare, drive down costs for everyone and improve outcomes for patients."
Azar's address ran along the same lines as the address he delivered earlier this week to the Federation of American Hospitals, as he promised "bold measures" to drive a sea change to value-based payments by leveraging Medicare and Medicaid. These measures would go beyond "tinkering" with bundled payment models, he said.
Over the past year, the CMS' moves on various payment models championed by the Obama administration sparked concerns that the Trump administration would reverse the course toward value-based care. In recent months the CMS has canceled mandatory bundled-payment models promoted by the Obama administration and reduced the number of providers who were previously required to participate in another.
An edited version of this story can also be found in Modern Healthcare's March 12 print edition.
