Another Insurer Leaves Missouri's Affordable Care Act Exchange
May 24 2017 - 2:34PM
Dow Jones News
By Anna Wilde Mathews
Blue Cross and Blue Shield of Kansas City plans to pull out of
the Affordable Care Act health insurance exchanges next year, a
move that leaves a region in northwestern Missouri at risk of
having no available marketplace plans.
The nonprofit said that after losing more than $100 million on
ACA plans through 2016, it will stop offering exchange plans in 30
counties in northwestern Missouri and two counties in Kansas. Blue
Cross and Blue Shield of Kansas City is the sole marketplace
insurer in 25 counties -- one-fifth of the total -- in Missouri,
according to the Kaiser Family Foundation.
"This is unsustainable for our company," said Danette Wilson,
chief executive of Blue Cross and Blue Shield of Kansas City, in a
statement. The move will affect approximately 67,000 people, the
insurer said. It began offering plans in 2014.
The decision by the Kansas City insurer is the latest sign of
strain in the ACA exchanges, which sell health insurance to
individuals. Humana Inc. and Aetna Inc. have already announced they
will next year leave all of the marketplaces where they currently
sell plans. Some insurers have been seeking large rate increases,
citing claims costs and regulatory uncertainty.
Other states are facing the risk that some exchange consumers
won't have any insurance products available. In Iowa, Medica has
said it is considering withdrawing from the exchange, a move that
could likely leave much or all of the state with no marketplace
plans following earlier departures by other insurers.
Earlier this month, BlueCross BlueShield of Tennessee filled a
potential gap left by Humana's exit when it said it would offer
plans in the Knoxville region next year.
Missouri is the latest state reeling from the loss of an ACA
exchange insurer. Last year, UnitedHealth Group Inc. and Aetna both
offered marketplace plans in the state, but they exited after 2016.
Humana is also a current Missouri exchange insurer, according to
the Kaiser foundation.
The lack of any exchange plans in a region presents a unique
challenge. The ACA mandates that most people acquire health
coverage, and offers subsidies to help lower-income consumers buy
plans. To obtain the subsidies, though, people are supposed to buy
their plans through health-law exchanges.
Federal regulators are able to spare people from the law's
penalty for non-coverage under certain circumstances, and they
could offer some sort of waiver to people in counties with no
exchange plans, experts said.
But the current law doesn't appear to leave any wiggle room that
would allow people in places with no exchange plans to obtain
subsidies to help with their premiums, experts said. If insurers
are still selling individual coverage outside the ACA exchange,
those consumers could potentially purchase it, but they wouldn't
get the federal aid. "I don't see any way around that," without
changing the law, said Timothy S. Jost, an emeritus professor at
Washington and Lee University.
Consumers like Doug McBride, 62, of Des Moines, are worrying
about what will happen. Mr. McBride, who owns his own photography
and video-production business, currently has an Aetna exchange
plan, and already knows he will have to switch insurers next year
when Aetna withdraws. But if no insurer offers plans on the
marketplace, he could lose access to the federal help that pays
about $1,000 a month toward his and his wife's combined monthly
premium of nearly $1,300.
Without the federal subsidy, Mr. McBride said, he would likely
not be able to afford coverage, and he would return to being
uninsured, as he was before the ACA's main provisions kicked in in
2014. "We are scared about it, we're really worried about it," said
Mr. McBride, who takes a blood thinner because of a clotting
condition stemming from surgery he got after an old injury.
Some companies, figuring that a number of consumers could be
trapped in such situations, are working on alternatives. EHealth
Inc. executives said the company is working on lower-cost coverage
options that will fall short of the full protections of major
medical plans, but likely be more affordable than ACA-compliant
insurance.
Write to Anna Wilde Mathews at anna.mathews@wsj.com
(END) Dow Jones Newswires
May 24, 2017 14:19 ET (18:19 GMT)
Copyright (c) 2017 Dow Jones & Company, Inc.
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