Contributor:
Bill Melville
Topics: Blue Cross Blue Shield,
exchanges
Several state health benefit exchanges now look a lot less
Blue, and that could leave consumers far from happy.
In three
states, Blue Cross Blue Shield plans have opted against selling exchange
policies. Another one, Regence Blue Cross and Blue Shield, opted out of
the Oregon health exchange but will still sell individual exchange
policies through a subsidiary.
These states should be the
exception. Most Blue plans have shown no signs of flinching, and WellPoint
has not backed off on plans to sell exchange policies in its 14 Blue
states. Blue Cross Blue Shield plans are traditionally the strongest
players in the individual and small-group markets in their respective
states and have been considered likely players in the exchanges.
But a few exceptions have surfaced. Wellmark, the nonprofit Blue Cross
Blue Shield plan and largest insurer in Iowa and South Dakota, will sit
out both state exchanges in 2014. Given its market dominance and the
ability to construct narrow networks around its ACO initiatives, Wellmark
seemed tailor-made for the health exchange market.
Wellmarkfs pass
could have financial repercussions for plans in the exchange. Sicker
residents and those previously covered by high-risk pools will be among
the health exchangefs first enrollees, so the threat of adverse selection
will loom over Iowafs exchange carriers, most of which will be smaller
than Wellmark.
Iowa, however, looks as if it could have a robust
market in which to spread that risk. Aetnafs Coventry Healthcare of Iowa
and CoOportunity Health applied for the individual exchange. Sanford
Health, Health Alliance Midwest and CoOportunity Health applied to sell
Small Business Health Option (SHOP) policies. Avera Health Plans and
Gunderson Health Plan each will participate in both but only in their
regions (northwest Iowa and northeast Iowa, respectively). The statefs
demographics should also help. Only 289,000 Iowans, less than 10 percent
of its population, go uninsured (HealthLeaders-InterStudy).
Other
states could be less fortunate. Mississippi has only had two carriers
apply for the exchange (Centene and Humana), and their coverage areas will
leave 36 Mississippi counties without a single exchange policy option.
Notably absent from the conversation about Mississippifs exchange is Blue
Cross & Blue Shield of Mississippi, which did not apply to sell
exchange policies. Typically, these non-metro counties are places where a
Blue plan would sell coverage.
The Mississippi Blue planfs actions
could indicate that other Blue plans in the southeast will spurn state
exchanges. Suddenly, a lack of Blue could be a plausible turn in
Louisiana, Alabama, and South Carolina.
As the exchange
participants become clearer, the threat of gcoverage deserts,h where the
uninsured have no plan options, becomes more real. At first coverage
deserts seemed to be an issue more likely in the western states, where
geographically large counties might only have a few thousand residents.
In Mississippi, almost half the counties – and an estimated 60,000
uninsured - will have no exchange policy available. That could be a
problem anywhere a Blue plan skips the exchange.
The majority of
Blue plans will still play in state exchanges. The danger lies in where
they choose not to play. For some states, a Blue plan bowing out of a
health exchange guarantees no oasis in a coverage desert.
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Bill Melville on Twitter @BillMelvilleHLI