The insurance industry's dominant lobbying group America's Health Insurance Plans last week named Matt Eyles as its next president and CEO, taking over from Marilyn Tavenner on June 1. Eyles, who is currently AHIP's chief operating officer, previously held roles at D.C.-based consultancy Avalere Health, Coventry Health Care (now part of Aetna), and drugmaker Eli Lilly and Co. Modern Healthcare insurance reporter Shelby Livingston caught up with Eyles to talk about his priorities for the trade group, the federal government's move to expand short-term plans, and the recent wave of proposed megamergers between insurers and nontraditional partners.
On his priorities as head of AHIP:
Looking ahead, it's really addressing issues related to the affordability of healthcare and how we make it easier and simpler for consumers. In the short-term, there are plenty of challenges that we think about, whether it be what's happening with the Medicaid program and what path that will be taking. Medicare Advantage, of course, continues to be important, and spending more time on the employer-sponsored market. Last but not least is individual market stability and really focusing on trying to get a premium-reduction package in place for the March 23 omnibus, focusing on a reinsurance program and funding for cost-sharing reductions. We really want to see consumers have more affordable, lower premium options in 2019 that also provide comprehensive coverage.
On lowering high prescription drug prices:
We're focusing on the core problem, which is the list price. We're focused on things that would get some real competition into the marketplace. The first thing in the short-term is getting the Creates Act enacted, which would end some of the gaming around access to drug samples that really can't be justified by any stretch. That would be something that would not just address issues related to patient out-of-pocket costs, but actually underlying prices. The second area is focusing on biosimilars, and realizing the potential of biosimilars to drive cost and price savings in the market.
On stabilizing the ACA individual market:
It's important to include (in a stabilization package) the cost-sharing benefit funding that was terminated in the fourth quarter of 2017. We think that's a key to long-term stability in the market. There's a benefit that by funding the cost-sharing reductions, you're able to pay for a substantial reinsurance program without the federal government incurring any additional costs. The second is by bringing that funding back, again in combination with reinsurance, we're able to reduce (premium) prices by double digits in 2019.
On proposals to expand access to short-term and association health plans:
We have some real concerns about short-term plans and association plans and how they operate, making sure that consumers know what it is they are actually getting. There are limited benefits in many cases, pre-existing conditions and medical underwriting and it poses challenges to the stability (of the market). Particularly if you're talking about products that would be available over the long-term and that would be renewable, it really does create sort of a parallel market structure that makes it very difficult—depending upon how the individual market moves forward—for both to exist in a way that would be stable.
On AHIP members interest in selling short-term plans:
A lot of people are just trying to figure out what is this market going to look like. There are some who clearly don't have any interest, and in some cases those policies are available already, but I think it's really trying to figure out what the rules are going to be, and for example, what's the role of states vs. the federal government? Today in five or six states, the short-term policies aren't even allowed. I think it's going to differ also by the level of stability within any particular market.
On Idaho's state-based plans that sidestep ACA rules:
States are just trying to figure out how they can make a circumstance workable within their state, and that's why we're seeing so many different circumstances whether it be in the individual market or how states are approaching Medicaid. Each circumstance is a little bit different based on what's happening close to the ground where people are getting care and coverage.
On some states' moves to implement Medicaid work requirements:
At a high level, the way we're approaching them is to look at the impact on access to coverage. Are they being put in place in a way that actually could be constructive long term versus really just acting as more of a way to limit people from getting access to coverage? It's a really small number as a percentage of healthy adults that would be impacted by these (requirements), but we're also mindful of what it means from a precedent perspective and how things might evolve.
On losing big insurance members, such as UnitedHealth Group, Aetna and Humana:
We are in as strong a position as we've been. Of course, our goal is to represent the entirety of the health insurance community and that's still our goal, but we finished last year in a strong financial position. We've grown membership overall. We've brought on new leadership and have done a good job in terms of helping to lead the industry through an incredibly tumultuous and uncertain time period and have had some very meaningful successes for our members. But our goal is to represent the entire community, and we are certainly interested in bringing all members and all companies back under the AHIP umbrella.
On megamergers between insurers and nontraditional partners, such as the CVS-Aetna and Cigna-Express Scripts deals:
It's really an interesting time characterized by a lot of disruption and I'd say innovation. (The combining companies) are all looking to provide a better consumer experience, to have lower cost, higher value, more convenient care, and leveraging all of these assets to help advance our healthcare system. So I think we are very well aligned in terms of where those organizations and companies are trying to lead the healthcare system and I'm confident that AHIP is in a strong position to help facilitate that leadership.
