As the only insurer to offer plans in the Affordable Care Act marketplace in all of Florida's 67 counties, Florida Blue is keeping a close eye on proposed changes from Donald Trump's administration.
Though Trump said he wants to repeal and replace Obamacare quickly, Florida Blue's CEO Pat Geraghty said any changes will likely take time to develop and implement.
"You literally have 20 million people who gained coverage through the Affordable Care Act. It would be political suicide to just cut them loose,” Geraghty said. “So we have to figure out what that transition looks like and it really gets to how will you finance that."
Geraghty said he is looking forward to working with Donald Trump's administration on a replacement.
He expects the Trump administration to do away with subsidies and move to tax credits. He also expects Trump to find new ways to deal with high-risk patients who are difficult to insure.
Lowering or removing several taxes contained in the law that were passed on to consumers would also improve the system, he said.
Many Democrats have said they agree that changes are needed but they were unable to make them with Republicans in control of the House of Representatives.
"We never got to the debate about how to improve the law that we had,” Geraghty said. “Now we're looking at how do we start over? So pragmatically we have to dig in, work with the people who are in charge and figure out how to start over."
Another change he'd like to see is a loosening of what insurers call a rating band. Under Obamacare, the highest rate for insurance paid by consumers can not be more than three times the lowest rate paid by consumers. Before Obamacare the difference was 7 to 1, which allowed younger people to get insured at a lower rate.
A change, Geraghty says, would bring more low-risk consumers into the insurance pool.
Though Trump has provided few details about his plan to replace Obamacare, he has said he would like to allow insurers to sell across state lines.
Geraghty said he agrees with injecting more competition into the system, but isn't sure selling across state lines would work.
"You're talking about taking and interfering with the states' right to regulate insurance in their state,” he said. “Now the Republican party has long stood for states’ rights against the federalism of central control. So I think that concept is going to take a lot of debate in Washington."
Geraghty said he thinks Congress will give more power to states to control and regulate insurers.