36,000 People May Have No Health Insurance Exchange Options in 2018

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By Sara Hansard

Forty-nine counties with at least 36,000 enrollees altogether may have no health insurance offerings in their Obamacare exchanges in 2018, the Department of Health and Human Services reported June 27.

The county-level map of projected issuer participation in the Affordable Care Act exchanges released by the Centers for Medicare & Medicaid Services showed an increase in areas that could be without coverage in 2018. On June 9, the CMS projected there would be 47 counties with 35,000 exchange enrollees without coverage. Issuers have until Sept. 27 to submit final signed agreements.

The report of additional areas that may have no exchange participation comes as the Senate grapples with voting on its version of legislation to repeal and replace Obamacare. Congressional Republicans and the Trump administration argue that Obamacare is imploding as insurers withdraw from the money-losing exchanges, while Democrats point to Congressional Budget Office estimates finding that 22 million fewer people would be insured if the Senate Republicans’ Better Care Reconciliation Act (BCRA) becomes law.

About 12.2 million consumers enrolled in the ACA marketplaces during the 2017 open enrollment period that ended Jan. 31, the CMS reported. The Senate has delayed a vote on its bill until after the July 4 recess to try to get enough Republicans to pass the bill.

Continued Decline in Issuer Participation

“We continue to see a decline in issuer participation in the Health Insurance Exchanges leaving consumers with fewer and fewer insurance options,” CMS Administrator Seema Verma said in a release. “I am deeply concerned about the crisis situation facing the individual market in many states across the nation.”

As many as 1,300 counties, more than 40 percent of counties nationwide, could have only one issuer in 2018, representing as many as 2.4 million exchange participants, the CMS said.

In addition to insurers such as Anthem Inc. withdrawing from some counties, premium rate filings for 2018 appear to be rising sharply. Proposed 2018 premiums for the most popular type of exchange plan are 18 percent higher on average than in 2017, according to a June 19 analysis by health policy consulting firm Avalere Health of eight states where early filings were submitted.

Issuers are still in discussions with state insurance departments about rates and participation in the 2018 exchanges, the CMS said. Initial rate filings for the 39 states using the federal HealthCare.gov system were filed June 21, and the final deadline for issuer changes is Aug. 16, it said.

“The Department of Health and Human Services is committed to doing everything permitted under current law to provide patients with immediate relief from damage” the exchanges have “done to the individual and small group health insurance markets,” the CMS said. “HHS actions are intended to stabilize the markets, increase choices, and lower costs.”

Among those actions are tightening verification requirements for people enrolling for coverage outside of normal open enrollment periods because of changes such as moving or losing qualified coverage. The HHS started that process June 23.

Short-Term Individual Market Support

In addition to the CMS report, S&P Global Ratings published a report June 27 on the Senate bill. The BCRA is “very supportive” of the individual market in the short term, but will result in a drop in the insured after 2021, the company said in a release. For the Medicaid market, reduced Medicaid funding will put a greater burden on states and result in a sharp drop in Medicaid rolls, it said.

If nearly $50 billion in health insurance market stabilization funds included in the BCRA are implemented effectively, “a significant decline in the individual market enrollment between 2018 and 2021 could be avoided,” S&P Global Ratings said. “After 2021, however, when those funds drop to a much lower level, it will be unable to effectively offset the negative impacts of a lower value benchmark plan and no mandate,” it said.

The BCRA bases subsidies on plans that cover 58 percent of medical claims, while the ACA subsidies are based on plans that cover 70 percent of claims. The cbill also would repeal the ACA’s individual mandate under which most people must have qualified health insurance or pay a tax penalty.

To contact the reporter on this story: Sara Hansard at shansard@bna.com

To contact the editor responsible for this story: Brian Broderick in Washington at bbroderick@bna.com

For More Information

The CMS's county-level map of projected health insurance exchanges as of June 27 is at https://downloads.cms.gov/files/cciio/cciio-exchange-carriers-by-county-06-27-2017.pdf.The Congressional Budget Office's June 26 spending and revenue estimates of the Better Care Reconciliation Act is at https://www.cbo.gov/publication/52849.

The CMS's report on 2017 exchange enrollment is at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-03-15.html.

The June 19 Avalere Health analysis of early rate filings is at http://avalere.com/expertise/managed-care/insights/first-look-initial-rate-filings-show-premium-increases-decreased-participat.

S&P Global Ratings' June 27 report is at http://src.bna.com/qhl.

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