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North Dakota: Medica pulls out specifically due to CSR sabotage factor

In August I wrote that the situation in North Dakota was pretty straightforward: Three carriers on the individual exchange (BCBS, Medica and Sanford), requesting average rate hikes of around 24%, 19% and 12% respectively for an average increase of 23% assuming CSR payments are made, or a bit higher (28%) if they aren't.

Yesterday, however, with the final contract signing deadline having passed on the 27th, Louise Norris reports that one of the three carriers, Medica, was forced to drop out of the market at the last moment...not because they wanted to, but because the ND insurance dept. insisted on carriers pricing 2018 premiums on the assumption CSRs will be paid for the full year.

Medica understandably refused to take that risk (the odds of CSRs being guaranteed are virtually nil, and the odds of them being paid each and every month, as they're supposed to, is only so-so), so they dropped out instead.

Medica holds around 10% of ND's total individual market (roughly 3,900 people), of which around 3,100 are on the ACA exchange. Medica will apparently continue to sell off-exchange plans (thus bypassing the CSR issue altogether).

The numbers involved are small enough that this doesn't really impact the average rate hikes for the other 37,000 people in individual policies; they're still looking at roughly a 23.3% increase. The no-CSR rates would be around 28.2%, but that's a moot point now; the other two carriers will simply have to eat the loss next year if they don't come through.

UPDATE: According to Louise Norris of, the final approved rates for BCBSND and Sanford are slightly lower than I thought, shaving a point or two off the total: