Category: Access to Care

Anthem’s membership in the Affordable Care Act marketplaces will decline by 70% in 2018, executives told investors Wednesday on the insurer’s third-quarter earnings call. About 1.4 million people had ACA-compliant plans with Anthem as of Sept. 30, 900,000 of whom bought coverage on the exchanges.

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New Mexico Health Connections, a not-for-profit insurance co-op funded through the Affordable Care Act, is a month overdue in filing its second-quarter financial paperwork. And the co-op’s most recent documents, as well as federal ACA documents, show potentially large financial problems that could force New Mexico to shut the company down. This could be another potential black eye for the ACA’s co-op program, in which 19 of 23 companies have already gone under.

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This brief describes alternative forms of subsidized reinsurance and the mechanisms by which they spread risk and reduce premiums. For a given amount of funding, a particular program’s efficacy will depend on how it affects insurers’ risk and the risk margins built into premiums, incentives for selecting or avoiding risks, incentives for coordinating and managing care, and the costs and complexity of administration. These effects warrant careful consideration by policymakers as they consider measures to achieve stability in the individual market in the long term.

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Half of Virginia’s counties now are on track to have no health insurers offering Obamacare plans in 2018 after an insurer reversed a decision to sell individual health coverage in much of the state.

The pullback by Optima Health in Virginia ends a brief, two-week period in which every county in the United States was projected to have at least one Obamacare insurer next year.

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The government says about 500,000 fewer Americans had no health insurance the first three months of this year, but that slight dip was not statistically significant from the same period in 2016.

Progress reducing the number of uninsured appears to have stalled in the last couple of years, and a separate private survey that measured through the first half of 2017 even registered an uptick.

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Under the ACA, insurance companies must sell polices to people with chronic diseases and charge the same premiums paid by healthy people. But patients with pre-existing conditions in fact are being denied coverage when their insurance plans don’t cover medically-recommended treatments or when they place significant obstacles in the way. Many plans impose “utilization management” rules restricting access to drugs. Dr. Blinderman suggests a “preauthorized trial period” for all medications. Following this trial period, physicians could be asked to justify continuation of the therapy. Doing this would relieve patient suffering due to delays or disruptions in the amelioration of symptoms, reducing health-care costs in the process.

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The second-lowest silver plan is one of the most popular plan choices on the marketplace and is also the benchmark that is used to determine the amount of financial assistance individuals and families receive. Based on preliminary 2018 rate filings, the second-lowest silver premium for a 40-year-old non-smoker will range from $244 in Detroit, MI to $631 in Wilmington, DE, before accounting for the tax credit that most enrollees in this market receive.

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The individual market shrank by 15% between March 2016 and March 2017, including a 25% decline among unsubsidized policyholders.  The individual market is not “sound.”  Because of rising premiums, millions of people who are not receiving subsidies can no longer afford to buy individual policies, and millions more may forfeit their policies in the next round of rate hikes.

Relinquishing at least some regulatory authority to the states might produce more functional markets where insurers can offer consumers the coverage they want at a price they can afford.

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U.S. health insurer Anthem Inc said on Monday it will no longer offer Obamacare plans in Nevada’s state exchange and will stop offering the plans in nearly half of Georgia’s counties next year.

The moves come after Republican senators last month failed to repeal and replace Obamacare, former President Barack Obama’s signature healthcare reform law, creating uncertainty over how the program providing health benefits to 20 million Americans will be funded and managed in 2018.

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