Any efforts to halt progress on implementing the nation’s healthcare overhaul or to freeze funding are a step in the wrong direction even though some changes are needed, the president of Aetna Inc. told Reuters Wednesday.
Republicans, who made gains in Congress and numerous state houses in last week’s election, have vowed to target the reform law, enacted earlier this year. But Mark Bertolini, president of health insurer Aetna, said that could lead the industry to “a bad place.”
“A complete stalemate with a complete shutdown of funding would be problematic,” he said at the Reuters Health Summit in New York.
The law, which passed in March without a single Republican vote, enacts sweeping changes on the U.S. healthcare sector, particularly health insurers, which Democrats blasted for their coverage practices. Aetna is the nation’s third-largest for-profit health insurance company.
The law, which aims to expand coverage in 2014 to 30 million more Americans, requires insurers to cover those with preexisting conditions, among other consumer protections. It also imposes billions of dollars of new taxes on insurers and spending caps that push more of customers’ premiums toward care rather than other costs or profits.
Republicans campaigned on promises to “repeal and replace” the law but have since said it is more realistic to target specific provisions or funding. Despite Republicans’ imminent takeover of the House in January, Democrats still control the Senate and the White House and are likely to block any major changes.
Bertolini, however, said there is room to improve the law even as Congress and industry move on.
“We can’t go back. We need to keep moving, and we need to improve upon what we have,” said Bertolini, who starts as Aetna’s chief executive later this month and later as chairman in April.
One particular part of the law that some Republicans have promised to repeal is the mandate that people purchase health insurance policies or face fines. It is a provision that has also prompted several state lawsuits on the grounds that the federal government cannot force people to buy something.
Insurers have largely backed that particular rule, saying they need millions more customers to offset costs of new consumer protections and spending limits.
But Bertolini said Aetna would support an end to the mandate and still guarantee coverage to more people without restrictions. But he said special “high risk” funding protection would be needed.
He also he called for more changes to boost the quality of healthcare services, including a bigger government push to boost use of health information technology to expand sharing of patient records, test results and more.
More work also needs to be done to reshape how doctors and other healthcare providers get paid, with bigger overall fees rather than fee-for-service reimbursement, which that can result in unnecessary tests and office visits, he added.
In the meantime, however, Bertolini said current regulations from the health law “are workable” and need to be implemented even as Congress is likely spend the next two years further debating the issue ahead of the 2012 presidential election.
“We would hope that there would be a much more respectful and civil dialogue about what we need to do to get healthcare reform enacted.”
(Reporting by Susan Heavey; Editing by Matthew Lewis and Steve Orlofsky)
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