As President Donald Trump urged politicians to “let Obamacare implode,” suggesting that the law will unravel on its own and leave people across the country with no health-insurance options, states were finding their own ways to fill in the gaps in coverage for next year.
Ohio’s insurance commissioner announced July 31 that by working together with five companies, all but one of its counties would have insurance options next year on the exchanges created by the Affordable Care Act. Twenty Ohio counties had been at risk of being bare in 2018, with no insurers selling plans on the exchanges where people can buy health coverage with the aid of federal subsidies. That void was created in June when the major insurer, Anthem, announced that it would pull out of the state.
“Ohio has long had a strong insurance system, and once again our insurers stepped up at an important time for thousands of Ohioans, taking unprecedented action to provide access to health insurance for Ohioans who otherwise were without options,” insurance director Jillian Froment said in a statement.
A single Ohio county, Paulding County, still has no insurer expected to offer plans on the exchange. Ms. Froment said that regulators are searching for coverage options for that county.
State insurance commissioners have been working with companies to plug potential gaps over the past few months. After quite a bit of suspense over whether Iowa would have any insurers offering marketplace plans next year, the Midwestern insurer Medica stepped in to offer plans statewide. Missouri, once at risk of seen multiple counties lose their insurance options, was able to work with the insurer Centene to fill in bare counties.
“State insurance regulators have a fair amount of latitude to get plans to participate,” said Dan Mendelson, president of Avalere Health, a consulting firm. “There is a back-and-forth that provides some level of insulation from the craziness of the federal legislative process and the federal administrative process. The states really have an interest in providing continuity.”
The announcement leaves a dwindling number of U.S. counties — 19, to date — at risk of having no insurers selling exchange plans. There are 12,076 people enrolled in those counties who could potentially have no choices next year, according to the Kaiser Family Foundation.
Having a single insurer is far from the rich consumer choice that many envisioned, including then-President Barack Obama, who said people should “shop around in the new marketplace.” And all insurers are closely watching what the White House will do about billions of dollars in federal payments that help cushion lower-income Americans from their out-of-pocket health-care costs.
, including deductibles.
Mr. Trump has repeatedly threatened to stop making the so-called cost-sharing reduction payments to insurers. On Twitter, Mr. Trump referred to the payments as “BAILOUTS for Insurance Companies.”
The payments, projected to add up to $7 billion this year, are made directly to insurance companies, but their practical effect is to lower co-payments and deductibles for lower-income Americans who buy insurance on the exchanges. Households with income between $24,600 and $61,500 for a family of four, benefit from the payments.
A Tuesday decision by the U.S. Court of Appeals in Washington allowed 17 states to join the legal battle to defend cost-sharing subsidies.
Still, playing defense, some insurers were pre-emptively raising premiums for next year. For example, BlueCross BlueShield of Arizona last week announced a 7.2 percent average hike for 2018. But there would likely be no increase if the subsidies are guaranteed, the company said. And BlueCross BlueShield of North Carolina earlier requested a 22.9 percent average increase. With the subsidies, the company said that would have been 8.8 percent.
California Attorney General Xavier Becerra says uncertainty over the future of those subsidies had led to a 12.5 percent jump in projected premiums next year for plans on the Covered California insurance exchange.
“It shouldn’t surprise anyone that the Trump-generated instability, unpredictability, has made it difficult for insurance companies to determine what their rates will be for next year,” Mr. Becerra said. “It shouldn’t surprise anyone that they’re hedging for charging more for next year’s insurance plan than this year — just in case.”
Discontinuing the payments was seen as having the potential to undermine the work that state insurance commissioners have done to persuade companies to participate in covering their states’ counties — and would result in premium hikes.
“What we know from insurers is some insurers will make the decision not to participate in the exchange market in 2018 if the cost-sharing reduction payments are not funded,” Tennessee insurance commissioner Julie Mix McPeak said last week.
Those who tend to vote Republican could get hit hard, noted health care consultant Robert Laszewski, a former insurance executive.
“[Mr. Trump's] hurting his own people,” Mr. Laszewski said.
The next round of cost-sharing payments are due to be issued by the U.S. Treasury on Aug. 21.
Los Angeles Times and The Associated Press contributed.
First Published: August 6, 2017, 4:00 a.m.
