As state deadlines approach for payers to decide whether to continue offering plans in the Affordable Care Act (ACA) exchanges next year, a new report by Avalere found that 41% of counties may have only one payer option in 2018. It also estimates that 47 counties that cover about 34,000 enrollees would have no ACA exchange options. Many of those counties are rural with limited enrollment.
Avalere found that proposed premiums for the most popular type of exchange plans (silver) are expected to rise 18% on average compared to 2017.
In other ACA exchange news, Iowa and Washington state seem to have avoided more counties without any exchange options. Oscar has also announced it will stay in the New York exchange and expand into five other states: Ohio, Texas, New Jersey, California and Tennessee.
The percentage of counties currently with only one ACA option increased from 33% in 2017 to 41% in 2018. Avalere believes that percentage may shrink or increase before next year depending on uncertainty in the exchange market and healthcare reform legislation.
“The debate over the Affordable Care Act and cost-sharing reduction (CSR) funding casts uncertainty over the market,” said Dan Mendelson, president of Avalere. “But despite all of this activity, the vast majority of consumers will still have commercial exchange options in 2018.”
June 21 is the CMS-imposed deadline for payers to offer proposed rates for ACA exchanges in 2018, but the rates and insurers in the exchanges will likely change before open enrollment kicks off on Nov. 1.
There have already been many twists and turns in the ACA exchange saga this year. The Republican-led Congress and the President Donald Trump administration have sent mixed messages about whether they will continue paying CSR subsidies, which helps cover lower income Americans. Trump has used withholding the money as a bargaining tool in hopes of getting Democrats to support Republican-backed health reform plans.
Healthcare reform, which threatens to repeal the ACA, and the unknown about CSR payments continues to cause payer unease, which has led some insurers to drop ACA exchanges plans, while others proposed double-digit rate increases.
It hasn't been all bad news for the exchanges. Centene announced it will expand its ACA offerings to another three states. BlueCross BlueShield of Tennessee also said that it planned to move back into 16 counties in eastern Tennessee that would have no exchanges options after Humana announced it’s pulling out.
Meanwhile, some payers have said they will stay in the exchanges despite suffering financial losses. CareFirst BlueCross Blue Shield said it will remain in Maryland, Virginia and D.C. exchanges for another year, but plans a 58% increase for the plans next year. BlueCross BlueShield of North Carolina also said it’s staying in all 100 North Carolina counties. The payer is proposing a nearly 23% rate increase unless federal leaders pay CSR payments. If that money comes, the company said the rate increase will drop to 5%.
However, for every piece of good news, there has been plenty of bad news about the exchanges. Aetna announced it's leaving the exchanges in its remaining states — Delaware, Nebraska, Iowa and Virginia, and Wellmark Blue Cross Blue Shield will drop the exchange plans for next year after reportedly losing $90 million from them over the past three years. Wellmark already dropped out of South Dakota’s exchanges last year.
Blue Cross and Blue Shield of Kansas City also announced that it’s dropping out of the exchanges in 32 counties in Kansas and Missouri next year, leaving 25 Missouri counties without any choices in the exchange market.
Also, UnitedHealth, already scaled back from 34 states to three this year and said the company will only offer ACA exchange plans in a “handful of states” in 2018. Humana, which is down to only 11 states this year, said it plans to stop offering ACA exchanges plans altogether in 2018 and instead redouble efforts on Medicare offerings.
It's been a topsy-turvy world for payers this year. With the June 21 deadline upon us, we're closer to knowing what the ACA exchanges market will look like in 2018, but expect even more reshuffling in the coming months as payers and state regulators get a better idea of what to expect from Congress and the White House.