There are numerous other issues health plans would also like to see changed, says Fox, such as the mandatory rebates insurers have to pay out if they fail to meet the medical loss ratio. "That still has quite a bit of complexity in it for health plans to figure out how to do that, and I don't think people have fully figured out all the unintended consequences of that going forward," says Fox.
Removing prior authorization for emergency services is a concern as is the U.S. Supreme Court's ruling giving states the power to opt of out of expanding Medicaid. Fox says insurers question how PPACA reform can truly make healthcare more affordable for individuals, businesses, and families when there are so many places that premiums are removed from the current revenue cycle.
He says its simple math.
"If the health plans can't increase premiums enough to cover the costs that they're paying out, they will struggle economically. So their only choice is to increase premiums... which then start to make the costs prohibitive for individuals who will opt out into the state or federal subsidized programs. And that creates [another] whole set of questions of when does the state or federal governments get into being the health plan?"
Good question. Mr. President?