- Nearly 100,000 Nebraskans could have no choices in the individual market, after Blue Cross Blue Shield of Nebraska said it is pulling out of the Affordable Care Act (ACA) exchange market, the Omaha World-Herald reported. Medica Health, the only remaining payer in the exchange, has not made a final decision yet on participation.
- The Pennsylvania Insurance Commissioner said rate filings from payers in her state vary wildly depending on whether cost-sharing reduction (CSR) payments are made. The requests with the payments average 8.8%, but soar to 23.3% without them.
- In addition to concern about the CSRs, insurers say it is not clear whether President Donald Trump’s administration will continue to enforce the individual mandate, according to Morning Consult. Some payers have filed rates assuming no enforcement, and the Pennsylvania Insurance Department said if there is no mandate and no CSRs their rates would increase further to 36.3%.
Many of the largest payers have stated their plans for 2018, and now states are nervously watching smaller companies’ decisions, which could affect whether they have only one – or possibly no – choices in the individual market.
Already Nebraska and part of Missouri will have no choices and more than a dozen states will have two or fewer. States with less competition are likely to see higher rates. Markets with just one insurer in 2017 had median premium increases at nearly 30%, compared to 5% in regions with six or more, according to the Robert Wood Johnson Foundation.
Payers are just weeks away from the deadline for deciding whether they will participate in the exchanges and what rates they will be requesting. For many insurers, both decisions hinge on whether the administration or Congress will continue CSR payments, along with the question of individual mandate enforcement.
But there is no indication the White House, embroiled in several controversies and foreign policy situations, will take a clear stance and respond to insurers concerns.
Beth Fritchen, a partner at Oliver Wyman Actuarial Consulting, recently told Healthcare Dive payers will look at pricing, network strength and relationships with provider networks as they decide their participation, but their No. 1 goal is solvency. “For the most part, they’re going to look at their block of experience to date and can they sustain any losses or can they fix it,” she said.
Pennsylvania Insurance Commission Teresa Miller has been a frequent critic of federal actions regarding the ACA exchanges, which she says are the cause of any instability. “This proves what we already know – instability caused by adverse action from the federal government will do nothing but hurt consumers who are stuck in the middle,” she said in a statement.