Tuesday, May 30, 2017
By TOM MURPHY ~
Associated Press
People
shopping for insurance through the Affordable Care Act in more regions could
face higher prices and fewer choices next year as insurance companies lay out
their early plans for 2018.
Blue
Cross and Blue Shield of North Carolina is asking regulators for a 23 percent
price hike next year because it doesn't expect crucial payments from the
federal government to continue.
That
announcement comes after Blue Cross and Blue Shield of Kansas City said it will
leave the individual insurance market next year, a decision that affects about
67,000 people in a 32-county area in Kansas and Missouri.
The
Kansas City company's decision will leave shoppers in 25 counties with no
options for coverage sold on public insurance exchanges unless another insurer
steps in, according to data compiled by The Associated Press and the consulting
firm Avalere.
The
law's insurance exchanges are the only place people can buy coverage with help
from an income-based tax credit.
Other
insurers around the country, such as Aetna and Humana, have said they will not
offer coverage on exchanges next year, though several, including Centene, said
they will.
Options
are growing thin in many markets. The Kansas City insurer's decision means only
10 of Missouri's 115 counties will have more than one insurer selling coverage
on the exchange next year.
Blue
Cross and Blue Shield of North Carolina sells coverage in all 100 North
Carolina counties, and it is the lone option in 95. It said last week its
participation for next year is not guaranteed.
Insurers
still have a couple of months to consider their options before finally
committing to selling coverage in 2018.
The
North Carolina insurer said it expects no help from federal cost-sharing
reduction payments next year, and that's reflected in its initial rate request
that calls for a 23 percent price increase, on average.
If it
could be assured of the subsidies that are part of the law and have been paid
in the past, it said prices would rise about 9 percent. The insurer covers more
than 460,000 people who bought coverage on the exchange.
It said
about two-thirds of those customers get cost-sharing help, but the price
increase for providing insurance without this help will be spread over all of
its customers in that market.
"Many
ACA customers will pay more for coverage that is already a large portion of
their household income," said Brian Tajlili, director of actuarial and
pricing services for the insurer.
The
government has been giving insurers money to help customers with modest incomes
cover out-of-pocket expenses such as co-payments and deductibles. But the
future of those payments, which are separate from the income-based tax credits
that help people buy coverage, is in political limbo.
Republicans
had sued the Obama administration to stop the subsidies, and that case is tied
up in court. President Donald Trump's administration has sent mixed signals
over how it will pursue the case or whether the payments will continue.
Insurers want some assurance the payments, which total about $7 billion, will
continue through 2018.
Tajlili
said his company wants to see some sort of a legal guarantee, such as Congress
appropriating the money, to feel comfortable the payments will be made through
2018.
Some of
the biggest companies on the exchanges have not announced their coverage plans
for next year. Those include Anthem Inc., which covers more than 1 million
people through Affordable Care Act exchanges, offering Blue Cross-Blue Shield
insurance in large states like New York, California and Ohio.
Many
insurance companies have faced large financial losses selling this type of
insurance and have responded by raising prices or abandoning that kind of
coverage altogether. Blue Cross and Blue Shield of North Carolina said earlier
this year it lost $38 million on ACA plans last year and more than $400 million
between 2014 and 2015.
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