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Anthem cites market uncertainty in reducing non-group presence in California

August 1st, 2017 No comments

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Anthem explains its decision to withdraw from 16 of 19 of the state’s rating regions in an email sent today to individual plan members, with proviso it could boost California plan offerings in future:

Unfortunately, uncertainty in the health insurance market does not provide the clarity and confidence we need to offer affordable coverage to our members in 2018. Anthem is committed to affordable health care coverage and we’re truly sorry we can’t continue offering these plans. We hope to increase our plan offerings in California very soon.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Deficient economies of scale challenge Nevada non-group market

July 1st, 2017 Comments off

The scarcity of doctors and medical facilities in vast, thinly populated areas can mean higher costs to insurers. But Nye County, which borders Las Vegas’ Clark County, is one of the state’s largest rural counties — and all four companies will participate there. “It is puzzling to me how carriers are ensuring full county coverage to Nevada’s neighboring states, yet are at a potential loss about how to offer insurance for all but three of Nevada’s counties,” Sandoval wrote the same executives earlier this week. He told them that leaving the exchange vacant in 14 counties will set back years of work to nearly halve Nevada’s uninsured rate.

Source: Governor insists execs work to keep rural Nevadans insured | Charlotte Observer

Nevada Gov. Brian Sandoval is confronting a challenge facing the non-group medical insurance market in states where there are too few patients and providers to make for a viable insurance market. Coverage goes hand in hand with provider networks since without enough providers, coverage isn’t useful. Factoring in overhead, it’s no wonder plan issuers aren’t interested in playing, particularly facing the possible loss of cost sharing subsidies for exchange silver plans.

Even though the Patient Protection and Affordable Care Act pooled entire state non-group populations into a single statewide risk pool, provider networks are by definition local. In less populous areas, it’s possible only statewide integrated payer and provider plans are going to work. Federally Qualified Health Centers may also have to play a larger role in providing primary care in these areas, with the plans covering costlier services provided in more populated parts of a state.

Telemedicine can also play a role in access to consultations with distant specialists and post hospital discharge patient monitoring. But it requires robust advanced telecommunications infrastructure that is typically lacking in less densely populated areas. Here too, the federal government can play a constructive role in financing its construction in areas passed over by private sector providers.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

401 percenters face another year of double digit premium hikes — with likely political consequences

June 21st, 2017 Comments off

ASHEVILLE, N.C. — Jane and Abe Goren retired here five years ago to escape the higher cost of living they had abided for decades in the suburbs of New York City. They did not anticipate having to write monthly checks for health insurance that would exceed their mortgage and property taxes combined. Ms. Goren, 62, is paying nearly $1,200 a month for coverage through the individual insurance market (her husband, 69, is on Medicare) and accumulating enough debt that her sons recently held a fund-raiser to help. For next year, her insurer, Blue Cross and Blue Shield of North Carolina, has proposed raising premiums by an average of 22.9 percent, a spike it is blaming squarely on President Trump.

Source: Middle Class, Not Poor, Could Suffer if Trump Ends Health Payments – The New York Times

The Gorens are part of what I’ve dubbed the 401 percenters — households with modified adjusted gross incomes in excess of the 400 percent of federal poverty cutoff for advance premium tax credit subsidies offered via state health benefit exchanges. For plan year 2018, the likely loss of reduced cost sharing reduction (CSR) subsidies for households with incomes between 100 and 250 percent of poverty levels is being blamed for another round of double digit premium increases. The cost sharing subsidies are tied up in litigation over which branch of the federal government has authority to allocate the CSR funding to health plan issuers.

There’s bound to be a political blowback in next year’s mid-term elections over steep premiums in the non-group segment, particularly among voters older than 50 but under age 65 and not yet eligible for Medicare, a demographic with strong voter turnout.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Iowa files urgent ACA 1332 waiver request to preserve 2018 non-group market

June 15th, 2017 Comments off

Facing the prospect of no health plan issuers offering coverage in the individual, non-group medical insurance market in 2018, Iowa is urgently asking the federal government for a state innovation waiver under Section 1332 of the Patient Protection and Affordable Care Act. The proposed stopgap measure by the state’s Insurance Division requests federal premium and cost sharing subsidies be used to fund the Proposed Stopgap Measure (“PSM”) Plan. The plan would offer a single standardized benefit plan with an actuarial value of 68 to 72 percent with premium subsidies determined by age and household income. It also proposes the federal Affordable Care Act funding support a reinsurance program for individuals incurring medical expenses greater than $100,000.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

Anthem’s exit from Ohio non-group is a shot across the bow of official Washington

June 7th, 2017 Comments off

The Anthem exit in Ohio is especially worrying, however, given the massive swath of the country in which it is the sole insurer in the exchanges, according to Cynthia Cox, associate director at nonpartisan health policy think tank The Kaiser Family Foundation.”Anthem’s exit from Ohio could be the tip of the iceberg,” Cox told Business Insider on Tuesday. “Their reasons for leaving don’t appear to be specific to Ohio, rather about political and regulatory uncertainty coming from the White House and Congress. If Anthem leaves the market nationally, there could be hundreds of thousands of people without any exchange insurer.” In a statement to Business Insider, Anthem cited a number of uncertainties that could impact the market coming from the Trump administration and Congress. “The individual market remains volatile and the lack of certainty of funding for cost sharing reduction subsidies, the restoration of taxes on fully insured coverage and, an increasing lack of overall predictability simply does not provide a sustainable path forward to provide affordable plan choices for consumers,” said the statement.

Source: Anthem Obamacare exchange exit from Ohio – Business Insider

Cox raises an excellent point that suggests Anthem’s withdrawal from the Ohio non-group market is less about Ohio than national policy. Anthem is likely firing a shot across the bow of Washington, warning it to quickly provide a degree of certainty going forward — or all bets are off nationwide.

That’s bound to get attention given Anthem’s major presence in the non-group medical insurance market. In late April, Anthem tentatively indicated it would sell coverage in state health benefit exchanges for plan year 2018, but reserved the right to reverse course lacking clear federal policy direction, particularly with regard to reduced cost sharing subsidies offered to low income households and the Affordable Care Act’s tax on health plan issuers.

As some observers have noted, Anthem could simply raise premium rates by 20 percent on its silver level plans to make up for the potential loss of cost sharing reduction subsidies for income qualifying households as Anthem indicated in April. However, that would potentially accelerate adverse selection among households that don’t qualify for significant advance premium tax credits to offset higher premiums, particularly coming after steep increases for 2017 plans.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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