Trump could quickly doom ACA cost-sharing subsidies for millions of Americans

Where the Obamacare exchanges might have zero insurers in 2018

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Select a county
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Wheeler County
Yamhill County

 There are expected to be 2 insurers in this county in 2018, the same as in 2017.
About 14 thousand people are currently insured through the marketplace there.

Number of insurers in 2018 marketplace

Next year, dozens of counties across the country could be left with no insurance companies offering insurance in the Affordable Care Act marketplaces based on where things currently stand.

Nationwide, that could leave 35 thousand marketplace enrollees living in a county with no way to purchase affordable individual health coverage. (As it stands, people who receive ACA subsidies can use them only to purchase coverage in the marketplace.) In addition, 2.4 million could be left with just one insurer to choose from. That’s out of more than 10 millionenrollees total.

Since the ACA marketplaces opened in 2014, no county has ever been bare, although it briefly looked last year as if Pinellas County, Arizona, would lack any ACA insurer.

NUMBER OF INSURERS, 2014 TO 2018

2015
2016
2017
2018

What’s changing for 2018

LATEST ANNOUNCEMENT, JUNE 13, 2017

Centene enters three states, expands in others

Insurer Centene announced Tuesday it would “enter Kansas, Missouri and Nevada in 2018, and [expand] in six existing markets: Florida, Georgia, Indiana, Ohio, Texas and Washington.” It has not specified which counties would be affected.

Insurers have until early summer to decide whether they’ll remain in the marketplace next year, though deadlines vary by state. So these numbers are still in flux, and more counties could end up bare, or new insurers might join some marketplaces.

NUMBER OF INSURERS LOST 2017 TO 2018

 About 2.7 million people are enrolled in a marketplace that is slated to lose at least one insurer in 2018.

In Iowa, for instance, 94 of 99 counties appear at the moment to have just one insurer, Medica — and that company has also threatened to leave. In response, the state has asked the federal government for permission to restructure its marketplace and jettison certain elements to keep insurers in place. Wellmark, which previously announced it would not sell ACA plans in Iowa in 2018, has said it would stay if federal officials grant the state’s request.

Insurers across the country have cited uncertainties created by the Trump administration as a reason for ending their participation in the ACA marketplaces.

For months, the Trump administration has been silent on whether it will continue to pay “cost-sharing reductions” (CSRs) to insurance companies. These payments subsidize about 7 million consumers’ copays and deductibles, as opposed to other subsidies which that defray the costs of insurance premiums.

Eliminating subsidies could leave insurers to foot the bill

HOW AN EXAMPLE DOCTOR VISIT IS PAID FOR UNDER THE ACA

The patient, government subsidy and insurance contribute

LOW-INCOME

PATIENT

INSURANCE

COMPANY

HEALTH-CARE

PROVIDER

GOVERNMENT

Cost

of care

Cost-sharing reduction

Insurance

coverage

Co-pay

HOW IT WOULD WORK WITHOUT COST-SHARING REDUCTIONS

The insurance company has to make up the difference

LOW-INCOME

PATIENT

INSURANCE

COMPANY

HEALTH-CARE

PROVIDER

Insurer covers

more of cost

Insurance

coverage

Co-pay

No extra

government

subsidy

 

The above visualization is an example to demonstrate the cost-sharing reduction scenario. Areas are not representative of the share that each source would pay, which varies by patient, plan and medical procedure.

If the Trump administration were to stop paying the CSRs, consumers would still be entitled under the ACA to those reductions. Insurance companies would be forced to absorb those costs.

[Trump could quickly doom ACA cost-sharing subsidies for millions of Americans]

Some companies already have decided to hike up their 2018 premiums more than they would otherwise to position themselves for an adverse decision by the administration. Others have left the market entirely.

Where insurers are leaving for 2018 so far

Aetna
Delaware
3 counties
Iowa
76 counties
Nebraska
93 counties
Virginia
51 counties

A spokesman said “uncertainty that has surrounded the future of the exchanges for some time now” was a significant factor.(Story)

Anthem
Ohio
88 counties

Their announcement cited “an increasing lack of overall predictability” and “continual changes in federal operations, rules and guidance.” (Story)

Blue Cross Blue Shield of Kansas City
Kansas
2 counties
Missouri
30 counties
BridgeSpan Health
Idaho
44 counties
Community Health Plan of Washington
Washington
14 counties
Humana
Florida
7 counties
Georgia
9 counties
Illinois
30 counties
Kentucky
9 counties
Louisiana
7 counties
Michigan
9 counties
Missouri
5 counties
Mississippi
32 counties
Ohio
7 counties
Tennessee
30 counties
Texas
10 counties

The company said it was “seeing further signs of an unbalanced risk pool.” (Story)

Innovation Health Insurance
Virginia
19 counties
LifeWise Health Plan of WA
Washington
4 counties

As a subsidiary of Premera Blue Cross, this insurer also said it left due to rising costs, not uncertainty. (Story)

Molina Healthcare of Washington, Inc.
Washington
6 counties
Premera Blue Cross
Washington
2 counties

Rising costs in rural communities, not uncertainty, lead the carrier to exit. (Story)

UnitedHealthcare
Virginia
32 counties
Wellmark
Iowa
4 counties

The decision was driven by “financial risk and an uncertain outlook for the marketplace.” (Story)

About this story

2017 marketplace insurers and announced 2018 exits are from the Robert Wood Johnson Foundation. 2017 marketplace enrollment and 2014-2016 insurer participation are from the Kaiser Family Foundation; data for state-based exchanges are estimates. Because 2018 exits are based in part on compiled news reports, exit data may be incomplete. See something we missed? Email kim.soffen@washpost.com.

https://www.washingtonpost.com/graphics/2017/national/obamacare-marketplace-insurers/?hpid=hp_no-name_graphic-story-b%3Ahomepage%2Fstory&utm_term=.0742bed5b35b#41039

Author: connie dello buono

Health educator, author and enterpreneur motherhealth@gmail.com or conniedbuono@gmail.com ; cell 408-854-1883 Helping families in the bay area by providing compassionate and live-in caregivers for homebound bay area seniors. Blogs at www.clubalthea.com Developing a new site, www.avatarcare.net , for early cancer detection using genetics tests, telemedicine with electronic appointment scheduling with doctors, video chat with doctors, matching care providers with health consumers and a health concierge for all to reduce chronic care cost, find cancer cure and coordinate health care using predictive medicine and participatory.

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