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Health Insurance is in a delicate state right now. Inaction is causing reaction on the part of insurance companies. The bottomline is the market is extremely unstable.
This article is focused on the state of Texas, but it is a snap shot of what is happening in EVERY STATE. If you are reading this and are concerned please share the information and consider taking a simple action of contacting YOUR Senator's office via email or telephone to let them know your concerns. It will take you less than ten minutes.
Use this link: https://www.senate.gov/senators/contact/
Eight health insurers have formally exited Texas’ individual market for health coverage, a blow to competition in the Obamacare insurance exchange north of Dallas, in Cooke, Fannin and Grayson counties along the Texas-Oklahoma border.
Statewide, though, the eight companies comprise only 4 percent of the individual market, said Texas Department of Insurance spokesman Ben Gonzalez.
Still, because the withdrawals are effective for at least five years, they amount to a near-permanent shunning of a potentially lucrative book of business, both inside and outside the exchange, in the nation’s second most populous state.
The exits are likely to stoke the already sky-high anxiety of consumers and providers as well as insurance company officials about which insurers will remain in Texas’ individual market, to what extent and at what cost.
Blue Cross Blue Shield of Texas is the anchor of the state's Obamacare exchange -- and appears to be sticking, despite questions about continued federal subsidies for low-income customers.
Secretive talks in the U.S. Senate over the American Health Care Act, the proposed bill to replace Obamacare, and uncertainty about whether President Donald Trump’s administration will continue paying subsidies for low-income purchasers’ out of pocket costs have raised many questions about market stability.
Insurers have already begun scaling back options in other states, once again citing millions in losses from the Affordable Care Act.
Experts said Texas, where state GOP leaders have staunchly opposed the law and refused to run or encourage residents to buy in the exchange, is not immune to the attack of nerves.
The 'blues' are sticking
However, in a boost to the Texas exchange’s stability, it appears that the largest player, Blue Cross Blue Shield of Texas, which is the only carrier selling in every county, will remain in the Marketplace.
Blue Cross has submitted proposed products and rates for 2018 to the state insurance department, though it won’t finalize decisions on them until “early fall,” company spokesman Gustavo Bujanda said.
“We hope to again participate in the individual market, but haven't made any final decisions concerning our level of participation,” he said in a written statement.
However, top Austin health insurer lobbyist Jamie Dudensingstrongly signaled Blue Cross will be back.
In a statement decrying how the eight carriers’ formal withdrawal notices “demonstrate deep instability in the individual market,” she noted the situation could be worse.
“Unlike some other states, every county in Texas will have at least one health insurance option,” said Dudensing, who is chief executive of the Texas Association of Health Plans.
Bujanda, asked if the carrier will sell exchange products in all 254 Texas counties next year, declined to comment.
Continued participation by Blue Cross is vital, said Cynthia Cox, who conducts economic and policy research on the Affordable Care Act for the nonpartisan Kaiser Family Foundation.
She noted that 45 counties in Ohio, Missouri and Washington face the prospect of having no insurer in those states’ exchanges next year.
In Texas, only two of the eight departing insurers, Humana and Prominence HealthFirst of Texas, were still selling in the state exchange this year, Cox noted.
No 'zero-insurance counties’
Assuming Blue Cross keeps selling border to border and no other insurers bail, there would be 97 counties with just one insurer in 2018 — up from 94 this year, she said. But there are no "zero-insurance counties" on the horizon yet, Cox said.
Along the Red River, Cooke, Fannin and Grayson counties would have just Blue Cross. Fourteen other counties, in the Panhandle and South Texas, would go from having three insurers to two, she said.
"It's a mixed bag, but it still would be a better situation than some other states are in," she said.
Potentially more than offsetting the recent departures is the prospect that two insurers, Centene Corp. and Oscar Health, will expand their Texas footprint. Both have indicated they will, though vaguely.
On Tuesday, St. Louis-based Centene said despite market uncertainty, it is seeking regulatory approval to sell health plans in Texas and a handful of other targeted states in 2018. About 90 percent of its key demographic is eligible for subsidies, the announcement said. Nearly a year ago, when it appeared Fort Worth would have just one insurer in the exchange, Blue Cross, Centene expanded into Tarrant County.
New York-based Oscar, which was co-founded by the brother of White House senior adviser Jared Kushner, withdrew last year from the individual market in the Dallas-Fort Worth area. But it continued to operate in San Antonio and is scrutinizing new Texas markets.
Dudensing, the industry’s state trade group chief, said the individual market supplies coverage for about 1.5 million Texans. About two-thirds of them buy in Obamacare’s federally run Marketplace, she said. The rest purchase policies that comply with the federal health law but outside the exchange. In addition, there’s an unknown number of Texans with “grandfathered” policies they began buying before the federal law passed in 2010.
Some brokers say carriers such as Humana no longer will offer the old, pre-Obamacare policies. The brokers complain they have too few exchange plans to offer customers. In no Texas county is more than four offered; and in 219 counties, just one or two, according to Kaiser’s Cox.
Of them, 86 percent received a premium tax credit to assist with payments. Sixty-three percent received “cost sharing reductions” — the subsidies for low-income consumers that U.S. House Republicans have contended lack explicit legal authorization. Their future under Trump has been unclear.
Sticker shock
Last year, several Texas health insurers requested steep rate hikes for 2017. Blue Cross sought increases of 56 percent to 59 percent on exchange products, while another insurer’s increase exceeded 70 percent. Because of the federal subsidies, most though not all consumers didn't feel the higher premiums' bite.
With continued federal funding of the cost sharing reductions uncertain, some states such as Iowa have requested waivers to revamp their Obamacare exchanges. Others such as Alaska and Minnesota are pushing ahead with state “reinsurance” programs that would limit rate increases. Texas leaders continue their hands-off approach, irking Dudensing and other industry figures.
Conservative Dallas health economist Devon Herrick, meanwhile, has predicted more trouble ahead for the Texas exchange.
“It’s essentially a poor risk pool, and with poverty comes health issues,” said Herrick, a senior fellow with the National Center for Policy Analysis. “So you have some populations that are inherently unprofitable.”
No one state has the entire solution, Herrick said.
"The overarching problem is that the current market is very unstable," he said.
Liberal health insurance expert Stacey Pogue of the Austin-based Center for Public Policy Priorities said Washington is responsible for the turbulence.
“Uncertainty being sown at the federal level — by the Senate writing a health care repeal bill in secret and the Congress and administration’s unwillingness to ensure payments due to insurers — is hurting consumers in Texas,” she said.
Find your county
EPO is exclusive provider organization. Like a preferred provider organization or PPO, it lets you seek services without going through a gatekeeper doctor, which is the hallmark of a health maintenance organization or HMO. But a PPO can cover some out-of-network visits, while an EPO and HMO do not, except in an emergency.
In 2016, there was one complete withdrawal, by Humana Insurance Co., and five “partial” withdrawals, in which the carrier pulled off the Obamacare exchange but did not make a full exit from the Texas individual insurance market. The partial withdrawals were by Aetna, Allegian, All Savers, Southwest Life & Health Insurance Co. and United Healthcare Life Insurance Co.
What they said …
Kaiser Family Foundation analyst Cynthia Cox: "It's a large number of companies exiting. Even if they are small companies, it's significant. It could be worse.”
Blue Cross Blue Shield of Texas senior media manager Gustavo Bujanda: "We're working with regulators at the state and federal level to achieve a stable and sustainable market.”
Centene Corp., on its expansion plans in Texas and four other states: "We are still working through the filing and review process. We will not have specific details until the review is complete.”
Oscar Health chief executive Mario Schlosser: "We're confident that in the end, there will be a stable individual market next year. We're actively looking for ways to serve more members in new markets, including in the state of Texas.”
Texas Association of Health Plans chief executive Jamie Dudensing: "Other states are proposing state-based solutions to address the stability of the market before the market goes from bad to worse. ... Moving forward, state policymakers need to examine state-based solutions in the wake of the federal government's inability to act.”
Center for Public Policy Priorities senior policy analyst Stacey Pogue: "The companies that have announced plans to stop selling insurance to Texans not covered through their jobs cover a small share of the market today. But we may not yet know the full extent of how uncertainty caused by federal inaction will weaken the Texas market.”
National Center for Policy Analysis senior fellow Devon Herrick: "The architects of the Affordable Care Act and the American Health Care Act are trying to fix the market. It's in our best interest to have a functioning market. We all have the same goal. But we have different ideas for how to achieve it."
