- BlueCross BlueShield of Tennessee (BCBST) announced Monday it had made the "difficult but necessary decision" to reduce its 2017 marketplace participation from eight to five regions in the state.
- The company estimated the decision to cut its sales of both on- and off-marketplace plans will impact about 100,000 people in the areas of Memphis, Nashville and Knoxville.
- It added that it will continue to offer individual and marketplace plans in the five ACA regions where other options are not "readily available."
BCBST said it is close to losing a total of $500 million over the three years it has provided plans under the ACA. It called those losses "unsustainable" and blamed its pullback on the marketplace model and uncertainties around the ACA at the federal level that could lead to ongoing future losses. That concern comes despite the fact that the company was granted a record 62% premium rate increase for its 2017 individual plans, the Times Free Press noted. By scaling back, it said, it can protect its financial security for the rest of its three million members.
The company highlighted that it was making sure it would not leave any region without a marketplace option for coverage.
"We have tried to make the ACA Marketplace model work for Tennessee, but we believe there are too many uncertainties to continue participating on a statewide level as we have before," the company said in a prepared statement. "We’ve made this difficult decision carefully, with the intention Tennesseans in every Marketplace region will still have an option for individual coverage under the ACA."
The issue of insurer pullbacks has been rampant, leading to concerns around the U.S. about whether everyone will indeed have a marketplace option, and how many will still actually have choices--with 19% of marketplace consumers expected to face regional monopolies in 2017, compared to about 2%, in 2016.
Pinal County, Arizona briefly faced the possibility of lacking any option for 2017 until Blue Cross Blue Shield of Arizona, in a move similar to that of its Tennessee counterpart, announced it would re-enter the county to rescue it after Aetna unexpectedly left.
Some are calling for changes or other solutions around the ACA's individual mandate, which requires people to pay a fee if they choose not to obtain health coverage, arguing it to be unfair if the marketplace is failing to uphold its mission of providing choice. However, exemptions could be expected to worsen the already expensive risk pool of the ACA by letting more healthy people opt out, opponents say.
In Tennessee, even before BCBST's move, its insurance commissioner recently characterized the state's exchange as "near collapse." BCBST's statement noted it will continue to evaluate the marketplace to consider a future return.