St. Louis-based Centene Corporation announced it plans to expand its Affordable Care Act (ACA) exchanges plans for 2018. The payer plans to enter Kansas, Missouri and Nevada next year and expand its footprints in six existing markets: Florida, Georgia, Indiana, Ohio, Texas and Washington.
In making the announcement, Centene acknowledged the exchanges market is unstable and said it wants to work with regulators and policymakers to improve the market and coverage.
Centene now has 1.2 million members in exchange plans, which is an increase from 537,200 at the end of 2016.
Much of the recent news about the ACA exchanges is about payers pulling out, raising rates or analyzing whether to stay in the market despite the turbulence. Insurers are leery to re-up for 2018 without the White House and Congress publicly backing the cost-sharing reduction subsidies that insurers receive to cover lower income Americans in the exchanges. Without those subsidies, insurers say the market will collapse, or at the very least premiums will skyrocket.
There is also the concern about what healthcare reform will mean to the market. Senators are debating their version of an ACA repeal bill, but are keeping negotiations secret.
In announcing the expansion, Centene Chairman President and CEO Michael F. Neidorff said the company recognizes the uncertainty, but is “well positioned” to expand services.
Centene has 12.1 million members across 25 states, with 9.3 million members in Medicaid plans. In addition to Medicaid and exchanges plans, Centene offers plans for the Children’s Health Insurance Program, Medicare Part D and the Department of Veterans Affairs.
In April, the company announced 69% growth in the first quarter of the year compared to the same period last year. Part of its success stems from a decreased health benefits ratio of 88.7% last year to 87.6% in the first quarter of this year.
While Centene doubles down in the exchanges market, other payers are dropping out. Anthem recently pulled out of Ohio exchanges, which will leave 18 counties without an option, and Blue Cross Blue Shield of Kansas City announced it’s dropping out of the exchanges in 32 counties in Kansas and Missouri. That will leave 25 Missouri counties without an option.
Iowa has a similar situation, but the state’s insurance commissioner is requesting a “stopgap” plan that includes a reinsurance plan to help cover high-cost beneficiaries. The state is asking the federal government for $80 million to help pay for the plan.
As a way to keep up with all of the comings and goings, the CMS released a county-level map of 2018 projected participation in the exchanges, although it doesn't include the most recent data. In announcing the map, CMS Administrator Seema Verma took aim at the exchanges.
“This is yet another failing report card for the exchanges. The American people have fewer insurance choices and in some counties no choice at all. CMS is working with state departments of insurance and issuers to find ways to provide relief and help restore access to healthcare plans, but our actions are by no means a long-term solution to the problems we’re seeing with the insurance exchanges.”
That’s far from a ringing endorsement or a commitment to the exchanges’ future. Centene’s announcement is positive news for the exchanges, but the question remains how many other payers will follow suit — especially with President Donald Trump's administration's actively criticizing the exchanges. Payers have one week left to decide whether they will participate.