Two recently filed lawsuits illustrate continuing difficulties the administration faces in implementing the Affordable Care Act, particularly under the constraints imposed upon it recently by Congress. Specifically, the suits illustrate the legal difficulties for the administration created by Congress’ limiting of “risk corridor” payments—made to insurers with high claims costs—to amounts contributed to the risk corridor program by insurers with low costs. Last year, CMS announced that it would have only $362 million in contributions to pay out $2.87 billion in requested payments, and so would only pay out 12.6 cents on the dollar for payment claims.
. . .
Ohio’s co-op will become the thirteenth of the 23 co-ops created under the Affordable Care Act to fold.
The Ohio Department of Insurance requested to liquidate the state’s health insurance co-op, InHealth Mutual, the state announced Thursday. Nearly 22,000 Ohio residents will have 60 days to replace their InHealth policy with another company’s on the federal exchange.
“Our examination of the company’s financials made it clear that the company’s losses would prevent it from paying future claims should its operations continue,” Mary Taylor, the Ohio Director of Insurance and the state’s lieutenant governor, said in a statement.
. . .
Blue Cross Blue Shield of Texas, facing massive losses for its ObamaCare plans, has requested a 58% premium hike for 603,000 customers.
The company is pricing in the claims experience of customers that’s been far higher than expected after suffering a $770 million loss on its exchange plans in 2015, equal to 26% of premiums.
Overall, individual market insurers requested a 35% ObamaCare premium hike for about 1.3 million customers, calculated ACASignups.net, based on the full range of insurer filings available.
BCBS of Texas also is seeking an 18% increase for 353,000 members who buy plans via the small group market that caters to businesses with fewer than 50 employees.
. . .
News that a CareFirst BlueCross BlueShield subsidiary will stop selling bronze level plans on the Virginia marketplace next year prompted some speculation that it could signal a developing movement by insurers to drop that level of coverage altogether. The reality may be more complicated and interesting, some experts said, based on an analysis of plan data.
Bronze plans provide the least generous coverage of the four metal tiers offered on the insurance marketplaces, paying 60 percent of benefits on average, compared to 70 percent for silver plans, which are far more popular. During the 2016 open enrollment period, 23 percent of marketplace customers signed up for a bronze plan, compared with 68 percent who chose silver, 6 percent who picked gold and 2 percent who chose a platinum plan.
. . .
The House Oversight Committee released a report Wednesday detailing extreme misconduct surrounding Oregon’s failed $305 million taxpayer funded Obamacare exchange and is calling on the Department of Justice to open a criminal investigation.
“The documents and testimony show Oregon State officials misused $305 million of federal funds and improperly coordinated with former Governor John Kitzhaber’s campaign advisers. Official decisions were made primarily for political purposes. Cover Oregon was established as an independent organization by the legislature, and was not intended to be a wholly controlled subsidiary of the Governor’s political apparatus,” House Oversight Committee Chairman wrote in a letter sent to Attorney General Loretta Lynch and Oregon Attorney General Ellen Rosenblum.
. . .
ObamaCare premium increases will be higher than last year, according to a new analysis of early data.
The analysis from the consulting firm Avalere Health finds that proposed ObamaCare premiums for silver-level plans are increasing an average of 16 percent in nine states that so far have complete data.The proposed increases for silver plans, the most popular, vary widely, from a 44 percent average increase in Vermont to a 5 percent increase in Washington state.
The increases appear to be higher than last year on average. An Avalere analysis at a similar point in the process last year found an average increase of about 6 percent.
. . .
Smaller insurers with experience in Medicaid, such as Centene Corp. and Molina Healthcare, are outperforming the broader insurance industry on the federal health exchanges. Their success is putting a spotlight on their business model as the Obama administration and other insurers seek to stabilize the fledgling individual market.
If Medicaid-like plan features become the norm, consumers and medical providers would be substantially affected. Such plans are often popular in the exchanges for their low premiums, but consumers have criticized limits on their access to medical providers such as doctors. And physicians fault the plans for low reimbursement rates.
. . .
Health insurers have not had much to cheer about lately, when it comes to Obamacare. They have been losing money on exchanges, and there is little hope that will change. So, a large health plan in Pittsburgh has asked judges to give it Obamacare money the Administration promised, but Congress declined to appropriate.
As reported by Wes Venteicher and Brian Bowling of the Pittsburgh Tribune-Review, Highmark lost $260 million on Obamacare exchanges in 2014, and claims it is owed $223 million by taxpayers. Unfortunately, it received only about $27 million. And things are getting worse. To date, Highmark has lost $773 million on Obamacare exchanges.
. . .
Oracle has had enough of Oregon. The business technology giant has decided it will no longer take on new business with the state’s government amid an ongoing legal battle, Oracle senior vice president Ken Glueck told Fortune on Wednesday.
The decision follows a protracted legal tussle between the two parties over a disastrous state healthcare enrollment website that never came online. In 2011, Oregon enlisted Oracle to build a healthcare exchange website related to Obamacare after being impressed by the company’s sales pitch, according to a previous legal filing.
. . .