President Trump and congressional Republicans finally goaded the health insurance industry into defending the Affordable Care Act this week — sort of. But these companies’ pusillanimous response to the GOP’s direct threat to Obamacare’s survival is a reminder that the industry, which collectively has made hundreds of millions of dollars from the law, has in many ways been its worst enemy.
The health insurers’ rare outspoken defense of the law came via separate letters from the industry’s lobbying arms, America’s Health Insurance Plans and the BlueCross BlueShield Assn., to Trump and to congressional leaders. The letters warn that the Republican determination to undermine the ACA threatens to drive more insurers out of the individual market, push up premiums and other costs, and burden hospitals with more unpaid bills.
The Affordable Care Act’s insurance exchanges have become too risky for major health insurers, and that’s creating further doubt about coverage options consumers might have next year.
Anthem CEO Joseph Swedish said Wednesday his company is waiting to see whether the government makes some short-term fixes to the shaky exchanges before it decides how much it will participate next year. The Blue Cross-Blue Shield carrier is the nation’s second largest insurer and sells coverage on exchanges in 14 states.
Enrollment in the Obamacare insurance marketplace is likely to stall or even decline for 2017 as higher premiums drive away people who aren’t eligible for government subsidies, according to S&P Global Ratings forecasts.
“Our forecasted modest-to-negative growth is clearly a bump in the road, but doesn’t signal ‘game-over’ for the marketplace,” S&P analyst Deep Banerjee wrote in a report released Thursday.
The promise of Obamacare was that it would foster competition and offer lower premiums while covering tens of millions of Americans without, as Obama often put it, adding a dime to the deficit.
Unfortunately, most of the exchanges are in serious trouble. As many critics pointed out at the time, the law is poorly designed to induce younger, healthier people to get into the system. The penalties attached to the individual mandate are too weak. The subsidies are too small. The premiums are too costly. The deductibles are too high. Many doctors aren’t participating in the networks.
Industry giants Aetna (AET), UnitedHealthcare (UNH) and Humana (HUM) are scaling back their presences on the exchanges. And smaller insurers, including more than a dozen co-ops funded by the federal government to foster competition, have gone out of business or are dropping out of the program.
Nearly 36% of markets may have only one insurer participating on the exchanges, up from 4% this year, according to an analysis by Avalere Health, a consulting company. And nearly 55% may have two or fewer choices, up from 33% in 2016.
Tennessee’s insurance regulator approved hefty rate increases for the three carriers on the Obamacare exchange in an attempt to stabilize the already-limited number of insurers in the state.
The rate approvals, while a tough decision, were necessary to ensure that consumers around the state had options when open enrollment begins in November, said Julie Mix McPeak, commissioner of the Tennessee Department of Commerce and Insurance. BlueCross BlueShield of Tennessee is the only insurer to sell statewide and there was the possibility that Cigna and Humana would reduce their footprints or leave the market altogether.
Joe Cortelli, a health insurance expert from the nationwide consulting group HIG, explains:
“We have done nothing to improve the outcomes of the 10% of the population that drives 80% of our claims costs. We have merely pumped billions of dollars into these [ObamaCare] exchanges masking the real problems. Unless the government can continue to pump money into these exchanges, the end result is not that hard to imagine. It is not a question of how, but when, this will all come home to roost.”
The facts support this. Millions of previously uninsurable sick people are flooding the insurance market, driving premiums sky high. As noted in the Fiscal Times, “The combination of market forces and limitations imposed by the [ACA] will put enormous pressure on insurers to up their premiums.” The pressure on insurers is undeniable, including the $650 million losses recently reported by UnitedHealth.
One of the nation’s largest health insurance companies plans to enter the Obamacare marketplace in the Chicago area for the first time, bringing new competition as other insurers exit or go out of business.
The Chicago Tribune has confirmed that Cigna, based in Bloomfield, Conn., has filed plans to sell health policies to individuals and families who purchase their own coverage in the individual market. If the plans are approved by Illinois regulators, Cigna will start selling policies Nov. 1, when enrollment for 2017 Obamacare coverage opens.
Sixteen Obamacare co-ops have now failed. Illinois announced that Land of Lincoln Health, a taxpayer funded Obamacare co-op, would close its doors, leaving 49,000 without insurance. The co-op now joins a list of 15 other Obamacare co-ops that have collapsed since Obamacare’s implementation. Failed co-ops have thus far cost taxpayers more than $1.7 billion in funds that may never be recovered.
Co-ops were promoted as not-for-profit alternatives to traditional insurance companies created under Obamacare. The Centers for Medicare and Medicaid Services (CMS) financed co-ops with startup and solvency loans, totaling more than $2.4 billion in taxpayer dollars. They have failed to become sustainable with many collapsing amid the failure of Obamacare exchanges.
The last thing Democrats want to contend with just a week before the 2016 presidential election is an outcry over double-digit insurance hikes as millions of Americans begin signing up for Obamacare.
But that looks increasingly likely as health plans socked by Obamacare losses look to regain their financial footing by raising rates.