The Trump administration won’t penalize insurers for failing to verify the number of severely ill patients they’ve enrolled through the insurance exchanges. The Affordable Care Act mandated that third-party auditors and the Department of Health and Human Services validate that plans receiving risk-adjustment payments do indeed have sicker patients. However, HHS has struggled to get the program off the ground due, in part, to technical woes. Although HHS has been collecting audit data from the plans, it hasn’t held them accountable for discrepancies in their sick patient volumes.
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Aetna Inc. is quitting Virginia’s Obamacare market for 2018, the second state that Chief Executive Officer Mark Bertolini is exiting as he seeks to limit his insurer’s risks from the beleaguered health law.
“We will not offer on- or off-exchange individual plans in Virginia,” Aetna said in an emailed statement, citing $200 million or more in losses the company anticipates this year on individual products. The insurer also cited “growing uncertainty in the marketplace” for the plans.
UnitedHealth Group Inc., which has largely stopped selling ACA health plans, said last month it was pulling out of Virginia. Also in April, Aetna said it wouldn’t sell Obamacare plans on Iowa’s market next year.
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Aetna Inc. will again scale back its presence in the Affordable Care Act exchanges in 2018, saying it expects losses on the business this year.
Individual plans are a small share of Aetna’s overall business, and the insurer had already scaled back its exchange presence to four ACA marketplaces currently, down from 15 last year.
Aetna said it expects 2017 losses on its individual business will amount to roughly half its loss last year, which was $450 million.
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Even as Anthem, one of the nation’s largest insurers, reported an improved financial picture for the last year, the company warned on Wednesday that it would consider leaving some federal health care marketplaces or raising its rates sharply if the government does not continue subsidies to help low-income people.
Joseph R. Swedish, the company’s chief executive, set a deadline of early June for a decision on the subsidies, saying Anthem would weigh increasing rates by at least 20 percent next year.
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Although insurers have generally remained profitable overall since implementation of the Affordable Care Act, many companies participating in the individual market – where most of the major market reforms took place in 2014 – experienced substantial losses in this market in the early years of reform. The individual market is where just 7% of the U.S. population gets their insurance (and thus also represents a small share of most health insurers’ business), but the stability of the market and willingness of insurers to continue to participate is essential to the ACA’s success. Going into 2017, there were a number of high-profile exits and premium increases, raising concerns over the stability of the individual market. Although some local markets are likely fragile, the Congressional Budget Office expects the ACA individual market to remain stable across most part of the country.
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Insurance executives, as well as the head of the trade group America’s Health Insurance Plans, met with Seema Verma, administrator of the Centers for Medicare and Medicaid Services, on Tuesday. Insurers have been pressuring administration officials and lawmakers to fund the ACA’s cost-sharing reduction payments. Insurers have struggled to adjust to the individual marketplaces since the ACA created the exchanges, and the ACA’s uncertain political future has only added to the questions they face as they approach the June 21 deadline for filing their 2018 premium rate requests. That will be the first indication of how the individual exchanges fare next year.
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With time running out to set insurance prices and uncertainty surrounding whether the Trump administration will continue funding cost-sharing subsidies on the ACA exchanges, several states are giving health insurers a little more wiggle room to file 2018 rates. State insurance regulators hope an extra few weeks to price plans will be enough to ease the insurance industry’s jitters created by efforts to repeal and replace the ACA and keep insurers from bailing on the exchanges. Colorado, New Hampshire, Oregon and Kentucky have extended deadlines for insurers to submit rates for 2018 ACA health plans.
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Judicial Watch today released 944 pages of Department of Health and Human Services (HHS) records showing that the Obamacare website was launched despite serious concerns by its security testing contractor, Mitre Corporation, as well as internal executive-level apprehension about security.
The documents reveal that Mitre recommended a “Denial Authorization to Operate” in the month prior to Obamacare’s launch, noting that it could not adequately test the confidentiality and integrity of the system. It said that complete end-to-end testing of the system never occurred. Miter found that 11 “moderate” security findings and eight “low” findings remained open as September 19, 2013 – 12 days before the launch.
And an unsigned “Authorization to Operate” prepared just five days before Obamacare’s launch, indicates that the site’s “validation contractor” was “unable to adequately test the confidentiality and integrity of the [Federally Facilitated Marketplace] system in full.” That contractor, Blue Canopy, noted that they were able to access data “that should not be publically accessible.”
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The Trump administration says it is willing to continue paying subsidies to health insurance companies under the Affordable Care Act even though House Republicans say the payments are illegal because Congress never authorized them. The statement sends a small but potentially significant signal to insurers, encouraging them to stay in the market. The future of the payments has been in doubt because of a lawsuit filed in 2014 by House Republicans, who said the Obama administration was paying the subsidies illegally.
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A second major health-insurer has decided to quit selling individual policies in Iowa, raising fears that tens of thousands of Iowans will have no options for coverage next year.
Aetna informed Iowa regulators Thursday that it had decided to stop selling such policies, which cover people who lack access to employer-provided coverage or government plans. The move would affect 36,205 customers, the company told regulators.
Aetna’s move takes effect in January. It came three days after Iowa’s dominant health-insurer, Wellmark Blue Cross & Blue Shield, announced that it would no longer sell individual health-insurance policies in Iowa.
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