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Health Insurance CEO On Expanding Coverage


The debate over how to reform or repeal the Affordable Care Act might be stalled in Congress, but insurance companies are already making plans for 2018. Some insurance companies are pulling out of the Obamacare exchanges because of uncertainty about the federal government's commitment. That means a number of so-called bare counties in Nevada, Indiana and Ohio could lose all of their marketplace plans next year. But other companies have found a way to expand coverage. Centene Corporation is one of them. Its CEO, Michael Neidorff, joins us now from St. Louis. Mr. Neidorff, thanks so much for being with us.

MICHAEL NEIDORFF: Thank you. It's very nice to be with you.

SIMON: Do I get this right, your company has more than doubled in exchange customers in recent years?

NEIDORFF: Yes. We went from - in 2016, we had about 480,000 lives. And in '17, we have 1.2 million at the beginning of the year.

SIMON: So what are you doing differently?

NEIDORFF: Well, I think we're just doing our thing our way. We believe it's a good program. We're focused on our population, which is at the lower end of the socioeconomic scale. And it's a matter of giving them access, having the proper networks and truly medically managing it in the most constructive way. We believe the highest quality is the most cost effective, and we've been doing that. And it's working.

SIMON: But are you often alone in these areas? Are you often the only provider?

NEIDORFF: In some counties, we're the only provider. And that's fine because we want the very sick and the very well. We want that balanced book of business. So...

SIMON: Yeah.

NEIDORFF: ...You know, being the only one does not bother us.

SIMON: Well, it's very fine for you. But can you see where people might prefer to have more than one possibility for their health care coverage?

NEIDORFF: I am pleased when they have a choice. I can show you one county in Southern California where they have a choice. And we have 85 percent of the market, pushing 90 percent. So in fact, I like when they have a choice because it makes us look that much better.

SIMON: You, as we note, certainly seem to be doing well. But I gather you've said in interviews that the Senate's health care overhaul is headed in the right direction.

NEIDORFF: Well, I felt that where they were - it needed some more tweaking. It was headed in the right direction, in the right place. And I think it's now going to be very stalled. The parliamentarian ruled last night and was just studying all the things she said. But it's just going to further complicate what they can get done.

SIMON: Yeah. What kind of tweaks do you think need to be made?

NEIDORFF: Oh, I was looking to put in a - what we had titled the copper plan. And this was where there was wellness, a higher deductible and then catastrophic care for the young, healthy people who tend not to buy insurance because they're not going to need it.

SIMON: Yeah.

NEIDORFF: But when - if they had the right policy, I wanted to see reinsurance as opposed to high-risk pools. Reinsurance keeps the health plan involved on a - maybe an 80-20 basis. I'm getting a little technical on you.

SIMON: Yeah, I don't understand reinsurance.

NEIDORFF: Well, reinsurance is where if a case goes over, let's say, $100,000, there is a reinsurance pool within the state. They pick up 80 percent of the cost, but we still have 20 percent, which means we'll continue to manage it. And it's a way to handle catastrophic care without trying to rate everybody.

SIMON: Is it hard to do business, Mr. Neidorff, when you're in your business, if - in the midst of all this uncertainty?

NEIDORFF: No, I don't find it that way. We have taken the point of view that you make your decisions based on the facts as they are today, you know. If you do the what-ifs, you're going to be like what Ansoff once said over in Amsterdam, analysis by paralysis, or, I should say, paralysis by analysis. And so what we do is we're deciding, what do we have today? And we're playing by those rules, and it's working.

SIMON: Michael Neidorff is the CEO of the Centene insurance company. Mr. Neidorff, thank you very much for speaking with us, sir.

NEIDORFF: It was my pleasure. Thank you.

(SOUNDBITE OF TYCHO'S "AWAKE") Transcript provided by NPR, Copyright NPR.