A former vice presidential candidate who has been relativelymoderate on health insurance issues told health insurers Thursdaythat leaving counties without commercial individual health insuranceoptions in 2018 could force Congress to set up a universal Medicarebuy-in program.

Sen. Tim Kaine, D- Va., talked about the pressure for thecreation of a universal Medicare buy-in program at a hearing on theindividual health insurance market organized by the Senate Health,Education, Labor and Pensions Committee.

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"I don't think it's unfair for Anthem and other companies tosay, 'Give us some stability,'" Kaine told Robert Ruiz-Moss, ahealth insurance industry executive. Insurers deserve to know howthe federal government's rules, funding levels and publicexchange program marketing efforts will be like, Kaine said.

But "the 'bare county' phenomenon creates incredible pressurefor us to provide a solution, so people can have health insurance,"Kaine said. "We will provide a vigorous public option to allowpeople to buy into Medicare."

The Hearing

Thursday's individual health market hearing was the last hearingin a series of four individual health hearings organized by theSenate HELP Committee.

The committee has posted a package of hearing materials,including a video recording and written versions of the witnesses'testimony, here.

In addition to Ruiz-Moss, the witness list for today's hearingincluded Dr. Manny Sethi, an orthopedic trauma surgeon fromNashville, Tennessee; Dr. Susan Turney, chief executive officer ofMarshfield Clinic Health System Inc. in Marshfield, Wisconsin;Christina Postolowski, the Rocky Mountain regional director forYoung Invincibles; and Raymond Farmer, the director of the SouthCarolina Department of Insurance and the secretary-treasurer at theNational Association of Insurance Commissioners.

The witnesses asked Congress to keep the current Affordable CareAct cost-sharing reduction subsidy program in place in 2018 and2019, and to provide a replacement for the ACA reinsurance program,a program that was designed to expire at the end of 2016.

Ruiz-Moss, who is a Denver-based vice president in theindividual market segment at Anthem Inc., talked in the writtenversion of his testimony about health insurers' need for regulatorystability.

Insurers now face basic questions about rules and fundingsources for 2018, Ruiz-Moss said.

Even in calmer times, "Health plans serving consumers in theindividual market are regulated by two, and, in some cases, threeor four separate government entities with varying requirements,mandates and timelines to follow," Ruiz-Moss said.

Implementing even small changes in individual health rules canbe tremendously burdensome, he said.

Medicare Buy-In Program

Kaine was Hillary Clinton's vice presidential running mate in2016. Before he entered the Senate, he was governor ofVirginia. While he was the governor of Virginia, he appointedMarilyn Tavenner to be his secretary of Health and Human Services.Tavenner is now the president of America's Health Insurance Plans,a major health insurance company trade group.

At press time, Kaine was not on the list of cosponsors of S.1804, Sen. Bernie Sanders' "Medicare for All" single-payer healthinsurance bill.

In 2016, Kaine held back from cosponsoring Senate Resolution561, a bill that expressed support for the idea of setting up apublic health insurance plan that would be open to everyone in theUnited States.

Kaine said at the hearing that he personally does support theidea of letting all Americans buy into Medicare, but that he doesnot have the votes to make that happen.

Today, Kaine said, he does not have the votes to create auniversal Medicare buy-in program.

If, however, some counties lack commercial individual healthinsurance options in 2018, "I will get the votes," Kaine said.

Any Medicare buy-in program created would probably be broad, andnot aimed only at uninsurable people, or only at people in countieswithout commercial individual health insurance options, Kainesaid.

The Medicare buy-in program would be broad partly because theprogram designers would face the same kind of actuarial pressurethat commercial health plan designers face to make the program riskpool as broad as possible, Kaine said.