Wellmark Blue Cross Blue Shield announced it will not sell health plans on Iowa Affordable Care Act (ACA) insurance exchanges next year, a decision that will affect 21,400 of the 1.66 million Wellmark beneficiaries in Iowa.
Wellmark pointed to losses of around $90 million on exchange health plans over the last three years and Wellmark President John Forsyth told the Des Moines Register that too few young and healthy patients were signing up.
- Medica and Aetna are the only other payers currently participating in exchanges in many parts of Iowa and neither has committed to continuing participation next year.
Wellmark is officially out of the ACA insurance exchange business after calling it quits in Iowa. The payer stopped selling exchange plans last year in South Dakota, the only other state where it had operated in such markets.
Forsyth hinted in the announcement that the decision to exit Iow exchanges was driven by a lack of direction from lawmakers. “While there are many potential solutions, the timing and relative impact of those solutions is currently unclear,” Forsyth said. “This makes it difficult to establish plans for 2018.”
Wellmark could have made the decision to exit exchanges even if the American Health Care Act had drawn support or if an administration supportive of the ACA were in control. The payer pointed to several familiar complaints. They are losing money because too few young and healthy patients are purchasing insurance exchange health plans.
Healthcare reform efforts in Congress are stalled at the moment or on life support or just about to strike a deal depending on who you ask and what Twitter accounts you follow. Government could take steps to encourage payer participation in insurance exchanges. President Donald Trump's administration could clearly indicate its position on cost-sharing reductions, the individual mandate and risk corridor lawsuits.
For now, it seems that cost-sharing reduction payments will continue. However, payers likely need a lot more direction before they can commit to insurance exchanges for next year, especially with a June deadline approaching to submit initial health plan designs. Humana is out for next year and Anthem is leaning in that direction. More payers could follow unless clarity is provided quickly.