Anthem

Last week I wrote about how my friend Laura Packard, along with up to 44,000 others, is in serious danger of losing access to critically important cancer treatment and other services due to a falling out between one of the largest health insurance carriers and one of the largest medical centers in Colorado:

Denver-area Anthem customers on Colorado exchange forced to switch doctors

DENVER (KDVR) — Laura Packard was diagnosed with stage 4 Hodgkins-Lymphoma cancer in 2017. The 44-year-old moved from Nevada to Colorado in 2019 for one reason: the state’s heath insurance exchange that provides affordable options to individuals who otherwise can’t get coverage.

Doctors at UCHealth have continued to treat Packard to make sure she stays cancer-free.

I first wrote about Laura Packard here 3 1/2 years ago when she was first diagnosed with Hodgkins, though I've known her personally for a good 15 years or so. When she was diagnosed, her outlook was bleak; fortunately, she has since recovered and is now doing great:

In the spring of 2017, I was diagnosed with cancer (stage 4 Hodgkin’s Lymphoma). After a grueling 6 months of chemotherapy and a month of radiation treatment, I am in remission. For now. Hopefully forever.

The Affordable Care Act saved my life. But all the time I was fighting cancer, I had to fight my own U.S. Senator and my President in order to keep my health insurance. The day after my first chemotherapy session, the Republican House voted to dismantle the ACA. The “skinny repeal” of Obamacare was voted down in the Senate by one vote a couple days before my 7th chemo session. And the day after my 15th radiation session, I was thrown out of my (former!) U.S. Senator’s public forum for asking him about his health care record.

Last year, Virginia residents experienced massive amounts of heartburn and ulcers as two major insurance carriers, Optima (Sentara Health) and Anthem (HealthKeepers) played musical chairs with both their 2018 rate filings and which areas of the state they offered plans on.

In May 2017, things didn't look too bad: Both Anthem and Optima were available in fairly large chunks of the state, and while Anthem wanted to raise rates an ugly 38% on average, Optima was only looking to increase rates by around 10-11%.

UPDATE: As noted in the comments below, it looks like Anthem won't be expanding to cover the entire state after all. Even so, this is a major improvement in the situation.

Every year, Virginia is the first state out of the gate with their preliminary healthcare premium rate changes for the following year, posting the initial rate requests in early May. For 2019, it originally looked like the carriers were asking for a statewide average increase of 15.2%, but I later corrected this to 13.4%.

However, these were just preliminary numbers. The requests still have to go through the rate review process, and the carriers often make other changes as well before the final deadlines pass.

Last August, I woke up at 3am with excruciating pain in my abdomen on my right side. I tried to "walk it off" (bad cramp?), go to the bathroom (bad gas?), force myself to throw up (low-level food poisoning?) and drank a big glass of water (dehydration?) all to no avail. In utter agony, I finally had my wife wake up our son so she could drive me to the emergency room. I was especially worried because of the location of the pain; I feared I might be suffering from appendicitis, which is, of course, potentially deadly if not treated immediately. Even if it wasn't, it hurt like hell.

About five hours, an IV pain medication drip and a CT scan later, I was sent on my way back home with a less serious diagnosis: A kidney stone. Nasty and painful, but not generally fatal (although they can be if left untreated too long, causing sepsis).

A few weeks later I got the bill: $600. Not a lot of fun to pay of course, but it was much better than the official cost of the ER visit: $6,000. BCBSMI paid the other 90% of the cost.

August 11, 2017:

Anthem said Friday afternoon it planned to scale back statewide individual coverage in Virginia on the public exchange under the Affordable Care Act amid inaction by the Donald Trump White House on cost-sharing reduction subsidies.

Anthem, which operates under the Blue Cross and Blue Shield plan in 14 states, has already scaled back its Obamacare offerings in Indiana, Ohio and Wisconsin amid an unstable individual market for plans operating under the ACA.

“Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to a shrinking and deteriorating Individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost sharing reduction subsidies and the restoration of taxes on fully insured coverage,” Anthem said in a statement Friday afternoon. “As a result, the continued uncertainty makes it difficult for us to offer Individual health plans statewide in Virginia.”

UPDATE: Note that Anthem made these statements BEFORE Molina drew their line in the sand re. CSR payments. That could be a game changer.

I'll let Tami Luhby of CNN/Money take the floor:

Anthem says Obamacare business doing 'significantly better,' but still may exit some areas. https://t.co/ToFAvXj62t via @CNNMoney @luhby

— Tami Luhby (@Luhby) April 26, 2017

$antm CEO: "Individual business is doing markedly better than last year." But claims are slightly higher than expected.

— Tami Luhby (@Luhby) April 26, 2017

 

(This is an updated version of a post from February 1st):

COSMO: When I was in prison I learned that everything in this world, including money, operates not on reality...

MARTY: ...but on the perception of reality.

COSMO: Posit: People think a bank might be financially shaky.

MARTY: Consequence: People start to withdraw their money.

COSMO: Result: Pretty soon it is financially shaky.

MARTY: Conclusion: You can make banks fail.

COSMO: Bzzzzt! I've already done that. Maybe you've heard about a few? Think bigger.

MARTY: Stock market?

COSMO: Yes.

MARTY: Currency market?

COSMO: Yes.

MARTY: Commodities market?

COSMO: Yes.

MARTY: Small countries?

COSMO: I might even be able to crash the whole damned system.

Friday, January 20th:

A few months ago I noted that while UnitedHealthcare and some other carriers may be losing money hand over fist on the ACA exchanges, at least some of them are making a profit, breaking even or at least cutting their losses down to a reasonable level.

In the past few days, this has become increasingly clear, as Centene's news from yesterday shows.

As Kevin Drum at Mother Jones notes (quoting Richard Mayhew of Balloon Juice):

As a simple reminder, competitive markets should see some companies make money and some companies that offer more expensive and less attractive products lose money. I would be extremely worried if everyone was making money after three years, just like I would be extremely worried that everyone was losing money after three years of increasingly better data.

After UnitedHealthcare freaked everyone in the health insurance investor community out (along with enrollees, politicians, healthcare reporters/pundits, etc.) with their Thursday morning announcement that they might drop off the ACA exchanges in 2017, just 2 years after entering the exchanges and just 1 month after painting a rosy picture of the situation, several other major players in the individual market decided to calm everyone the hell down:

U.S. health insurers Aetna Inc and Anthem Inc on Friday sought to reassure investors that their Obamacare businesses had not worsened after UnitedHealth Group Inc warned of mounting losses in that sector.

Aetna and Anthem said their individual insurance businesses, which include the plans created by President Barack Obama's national healthcare reform law, had performed in line with projections through October. Both backed their earnings forecasts for 2015.

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