Wellmark Blue Cross and Blue Shield announced Tuesday that it will narrow its choices for individual Affordable Care Act plans in Iowa and will eliminate ACA individual plans in South Dakota altogether in 2017.
First, some clarification: Wellmark isn't on the exchange to begin with, and wasn't planning on joining it in SD next year, so this is a rare case of a carrier dropping their off-exchange individual market offerings. Since all of Wellmark's indy enrollees in South Dakota are paying full price, this one can't be blamed on APTC enrollees being sicker than average, etc.
More than 75,000 Iowans will see their insurance premiums rise next year.
Iowa Insurance Commissioner Nick Gerhart has approved rate increases sought by four companies who provide health insurance in the state, Gerhart's agency announced Monday. The increases include plans covered by Wellmark Blue Cross & Blue Shield, the state's dominant health insurer.
However, the article was a little vague about some of the data, so I visited the IA DOI website and sure enough, they have separate entries for every one of the carriers (with one exception):
The dominant carrier on the individual market in Iowa is Wellmark BCBS, which had 137,000 enrollees (something like 75% of all the market) last year.
However, there were two important caveats to that: First, Wellmark isn't currently participating on the ACA exchange; all of those enrollees were off-exchange only. Secondly, at the time I had no idea how many of them were ACA-compliant and how many were "grandfathered" or "transitional" policies, which aren't ACA compliant and which, more significantly, aren't part of the same risk pool.
When UnitedHealthcare announced last month that they were making good on their threat last fall to pull out of the individual market in over two dozen states next year, it caused shockwaves across the health insurance industry. It is an important development, as around 800,000 people will be impacted.
Iowa’s dominant health insurer has agreed to start selling policies a year from now that qualify for Obamacare subsidies.
Wellmark Blue Cross & Blue Shield has not participated in the Affordable Care Act’s online health insurance marketplace, which launched in the fall of 2013. The main effect of the company’s decision was that moderate-income Iowans could not choose Wellmark insurance if they wanted to purchase policies that qualified for new federal subsidies to help pay premiums.
Over at Forbes, virulently anti-ACA critics Josh Archambault and Jonathan Ingram have written a detailed analysis of What Went Wrong with Iowa's implementation of the Affordable Care Act's Medicaid expansion provision. While their tone is understandably hostile, from what I know of the situation, it seems to check out for the most part (granted, the only part of this piece I knew much about until now was the CoOportunity failure portion of it).
First, it's important to understand that Arkansas is not the only state which has been using a "private option" solution for their ACA Medicaid expansion program; Iowa opted for this as well. For some reason, Arkansas is the only state ever mentioned when this comes up, probably because they were the first ones to do so, I believe:
Iowa’s expansion was loosely modeled afterArkansas’ Obamacare expansion. Under Iowa’s “Marketplace Choice” waiver, able-bodied adults above the poverty line would receive Medicaid benefits through Obamacare exchange plans.
Iowa's chief insurance regulator has approved double-digit premium rate increases affecting thousands of Iowans.
The Iowa Insurance Division said Wednesday that Insurance Commissioner Nick Gerhart has approved increases requested by Wellmark Blue Cross & Blue Shield, Coventry Health Care and Gundersen Health Insurance.
All of the rate increases are for policyholders holding individual health insurance plans. They will go into effect Jan. 1.
This is an incredibly depressing post for me to write. Last month I received word that CoOportunity Health, one of the 23 co-ops set up as part of the ACA to offer competition with the Big Boys, had run into serious financial trouble and was being yanked off of Healthcare.Gov (they were operating in Iowa and Nebraska, both of which are on the federal exchange).
Anyway, as of December 10th, my contact at CoOportunity was unaware of any issues; they reported that everything was going great. On Christmas Eve, I was tipped off about CMS dropping CoOportunity from the exchange completely, but there wasn't a whole lot of detail given as to what had gone wrong beyond vague references to quarterly financial statements, cash flow and annual audits.
CLARKSTON, WA – Leaders with Washington’s Health Care Exchange are preparing for the second open enrollment period, but at the same time they are still working on resolving billing and computer problems for 1,300 accounts from the first sign-up period.
This is very confusingly worded, because it makes it sound like all 3 companies have been operating on the HC.gov exchange when it turns out that only 2 of them have. Wellmark did not participate in the ACA exchange; the 19,000 customers referred to here have off-exchange policies which are still ACA-compliant:
Commissioner Nick Gerhart said today that he has approved premium increases from Wellmark Blue Cross and Blue Shield, CoOportunity Health and Coventry Health.
A query from a viewer said he had received health coverage through the Affordable Care Act. To Ernst, he asked, "Have you given any thought to how individuals in my situation won't lose coverage, should repeal occur?"
Ernst called Obamacare a "job killer" in Iowa that is "taking personal health decisions out of our hands and placing them with nameless, faceless bureaucrats in Washington, DC." That is to some degree true, but what about the guy's question? It was a reasonable concern; millions of people are now receiving subsidies to purchase health insurance. If Republicans repeal Obamacare, what happens to them?