Five places most likely to lose ObamaCare insurers
By Rachel Roubein
06/06/17 06:00 AM EDT - The Hill
The immense uncertainty surrounding ObamaCare has some areas wondering
whether they’ll soon be in a dead zone — a place without any insurance plans to
buy on the healthcare exchanges.
Insurance companies are in the midst of filing premium requests
for the Affordable Care Act’s (ACA) marketplaces. But before seeking those
premium hikes, they’ll have to decide whether to continue offering coverage at
all.
It’s a difficult task, as Congress and the White House haven’t yet
committed to funding crucial payments to compensate insurers for subsidizing
out-of-pocket costs for some lower-income enrollees. It’s also unclear if
ObamaCare will continue to be the law of the land.
If the about $7 billion in payments to insurers aren’t funded, and
if core ObamaCare provisions — such as the individual mandate to buy insurance —
aren’t enforced, the damage to insurance markets could be severe.
But for some regions, the worry that there won’t be any insurance
plan to buy, or a limited number, is particularly acute — even before decisions
around the payments or what happens to ObamaCare are made.
Here are five places at risk.
Missouri
The state is facing an insurance commissioner’s biggest fear: bare
counties.
In May, Blue Cross Blue Shield of Kansas City announced it was
exiting the marketplace, leaving 25 counties in Missouri without any carrier
willing to sell ACA plans for 2018.
There’s still time, though.
Final decisions aren’t made until the fall, and officials are
likely trying to lure other insurers into the area behind the scenes.
That’s just what happened last year in Pinal County, Ariz., when
Blue Cross Blue Shield of Arizona stepped up to the plate. This year, the
Knoxville area was also saved by the company — Blue Cross Blue Shield of
Tennessee decided it would return to the area for 2018, with a few caveats.
“I think the Blues are, generally speaking, more committed to
staying in the individual market,” said Cynthia Cox, associate director for the
Program for the Study of Health Reform and Private Insurance at the Kaiser
Family Foundation.
“That’s what makes the Missouri situation more troubling than some
of the other places where we’ve been looking, is that without the Blue Cross
Blue Shield plan, it’s not clear who’s going to move into those counties.”
Iowa
Medica is the only insurer selling ObamaCare plans in most Iowa
counties, and it hasn’t made a final decision yet on whether it will stay or
leave, according to its spokesman, Larry Bussey.
Gundersen Health Plan sells in five Iowa counties, but it hasn’t
decided if it will participate again on the state’s exchange, spokeswoman
Jennifer Dinehart wrote in an email.
April wasn’t a good month for Iowa’s exchange. Both Aetna and
Wellmark Blue Cross and Blue Shield announced they wouldn’t sell individual
plans for 2018.
Wellmark’s chairman and CEO, John Forsyth, detailed what it would
take for the company to re-enter Iowa’s market in a Sunday op-ed in the Des
Moines Register. The list included incentivizing continuous coverage, tightening
rules for special enrollment periods, basing financial help on age and income,
offering reinsurance and allowing flexible plan design.
Nebraska
The state is in a fairly similar situation to Iowa.
Last month, Aetna announced it would exit its last ObamaCare
markets, which included Nebraska, and left Medica as the only carrier selling
plans to the state on the ObamaCare exchanges.
“Things are still changing daily,” Geoff Bartsh, vice president
for Medica’s individual and family business, told The Omaha World-Herald Friday.
“We’re still looking at changes and will continue to evaluate things. We are
still planning to participate in the Nebraska market for 2018. We haven’t made
any final decisions on that yet.”
Medica intends to sell plans on the state’s marketplace, Bussey
told The Hill.
Tennessee’s Knoxville area
Tennessee has already had to scramble to avoid coverage-free
areas.
Humana announced it wouldn’t sell insurance on the exchanges in
February, leaving the Knoxville area without any plans for 2018. The state’s
insurance commissioner, Julie Mix McPeak, quickly began conversations with the
two insurance companies left in the state to see if one would expand its
coverage.
Blue Cross Blue Shield of Tennessee obliged — but with a few
conditions. The company wanted to be able to exit the market “in the event of
any post-bid changes that destabilize the market,” it said in a letter.
More insurers could flee the ObamaCare markets if payments to
insurers aren’t funded and if the individual mandate isn’t enforced — or if the
uncertainty continues. Insurers aren’t locked into selling plans until the
fall.
They could also increase the cost of a plan, and a Kaiser analysis
shows an average 19 percent hike if cost-sharing subsidy payments aren’t
made.
“With all the uncertainty that insurers are facing next year, it
could very well be another area of the country that could pop up as being at
risk of having no company next year,” Cox said. “A lot can change between now
and September.”
Sen. Lamar Alexander
(R-Tenn.) — the chairman of the Senate Health, Education, Labor and Pensions
Committee — has been vocal about the need to temporarily repair ObamaCare.
He and the state’s other GOP senator, Bob Corker,
have proposed a bill that would let residents living in areas without an insurer
use their ObamaCare financial assistance to purchase any state-approved
plan.
Sen. Claire McCaskill
(D-Mo.) has the Democratic counter — those in bare counties could buy health
coverage on the D.C. exchange, which is where many lawmakers and congressional
staffers buy insurance.
Rural areas
Historically, rural areas have less competition in their insurance
markets — and that’s still true under the ACA.
On average, urban areas had 2.5 insurers participating in 2017,
compared to two insurers in more rural regions.
There are a number of rural areas with only one insurer, so if a
company leaves that state, it “could mean there is no coverage option for some
people living in those counties. In those counties with only one issuer, the
future of the exchange essentially depends on that one company,” Cox said.
“I think just within a given state the rural areas are probably
most at risk of having no insurance company,” Cox said. “It’s easier for a plan
to set up a favorable network in an urban area, and there’s also generally just
more insurers wanting to participate in urban areas.”