Some health insurers say they’re paying too much to rival Blue Cross Blue Shield plans under a key pillar of the federal health law designed to compensate insurers that take on sicker and more expensive patients. The critics’ chief complaint is that the Affordable Care Act’s risk-adjustment program unfairly rewards health plans—including Blue Shield of California—that have excess administrative costs and higher premiums. That comes at the expense of more efficient, lower-priced plans in the individual market, they say.
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Doctor and hospital switching has become a recurring scramble as consumers on the individual market find it difficult or impossible to stay on their same plans amid rising premiums and a revolving door of carriers willing to sell policies. “In 2017, just because of all the carrier exits, there are going to be more people making involuntary changes,” said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation, a New Jersey philanthropy. “I would imagine all things being equal, more people are going to be disappointed this year versus last year.”
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Ever since the Affordable Care Act’s insurance marketplaces opened for business in 2014, the Obama administration has worked hard to get Americans to sign up. Yet officials now are telling some older people that they might have too much insurance and should cancel their marketplace policies.
Each month, the Centers for Medicare and Medicaid Services is sending emails to about 15,000 people with subsidized marketplace coverage. The message arrives a few weeks before their 65th birthday, which is when most become eligible for Medicare.
Republicans have been vowing for six years now to repeal the Affordable Care Act. They have voted to do so dozens of times, despite knowing any measures would be vetoed by President Barack Obama. But if elected, a President Donald Trump wouldn’t have to wait for lawmakers to once again pass repeal legislation to stop the health law from functioning. Indeed, he could do much of it with a stroke of a pen.
Trump “absolutely, through executive action, could have tremendous interference to the point of literally stopping a train on its tracks,” said Sara Rosenbaum, a professor of law and health policy at George Washington University in Washington, D.C.
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Some of the Affordable Care Act’s insurance marketplaces are in turmoil as the fourth open enrollment season approaches this fall, but what’s ahead for consumers very much depends on where they live.
Competition on these exchanges will be diminished next year when three of the nation’s largest health insurers — Aetna, UnitedHealthcare and Humana — will sell individual plans in many fewer markets. So too will several Blue Cross and Blue Shield plans in various states. That’s on top of the 16 nonprofit co-ops that have closed since January 2015.
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A network of clinics that serves low-income patients in rural Northern California is finally finding balance after being deluged with newly insured patients under the Affordable Care Act.
After a more than two-year moratorium on nearly all new adult patients, the Redding-based Shasta Community Health Center has reopened its doors to some newcomers this month, and it will start accepting more new patients in September.
When Medi-Cal, California’s version of Medicaid, was first expanded under the Affordable Care Act in early 2014, the number of people insured under the program doubled to around 40,000 people in the region served by Shasta Community Health. Not only did the clinics see new patients, but the demand for services soared from existing ones who were newly insured.
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California’s Obamacare premiums will jump 13.2 percent on average next year, a sharp increase that is likely to reverberate nationwide in an election year.
The Covered California exchange had won plaudits by negotiating 4 percent average rate increases in its first two years. But that feat couldn’t be repeated for 2017, as overall medical costs continue to climb and two federal programs that help insurers with expensive claims are set to expire this year.
The increase announced Tuesday comes as major insurers around the country seek even bigger rate hikes for open enrollment this fall, and the presidential candidates clash over the future of President Barack Obama’s landmark health law.
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New failures are piling up among the member-run health insurance co-ops carrying out one of the Affordable Care Act’s most idealistic goals, leaving just seven remaining when the health law’s fourth enrollment season starts in the fall.
There were 23 in 2014.
For the rest — which all posted annual losses in 2015, according to the National Alliance of State Health Co-Ops — survival is job No. 1. Some are diversifying to serve larger employers, no longer limiting themselves to their ACA mandate to offer health plans to individuals and small businesses. A Maryland co-op has sued the federal government to avoid paying millions of dollars to other insurers under the ACA’s complex formula to keep premiums stable by balancing risks among insurers and helping ailing ones. Other co-ops are trying to renegotiate contracts with hospitals and other providers.
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Next year’s premiums for health coverage under the Affordable Care Act could rise more than in past years in most markets and declines might be rare, according to a preliminary analysis of insurers’ plans.
Overall, premiums for a popular type of plan — the second-lowest silver plan — could rise 10 percent on average next year in 14 major metropolitan areas, according to an analysis released Wednesday by the Kaiser Family Foundation. Kaiser based its projections on insurers’ preliminary rates filed with state regulators, which remain subject to state or federal review. (KHN is an editorially independent program of the foundation.)
Last year, premiums for the second-lowest silver plan in those metro areas rose 5 percent after state insurance departments signed off, Kaiser said.
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UnitedHealth Group Inc. is leaving California’s insurance exchange at the end of this year, state officials confirmed Tuesday.
The nation’s largest health insurer announced in April it was dropping out of all but a handful of 34 health insurance marketplaces it participated in. But the company had not discussed its plans in California.
UnitedHealth’s pullout also affects individual policies sold outside the Covered California exchange, which will remain in effect until the end of December.
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