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Obamacare State Exchanges in Midst of Uncertainty as Insurers Prepare to Exit

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Obamacare State Exchanges in Midst of Uncertainty as Insurers Prepare to Exit

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Updated: June 19, 2017    Published: June 19, 2017

Obamacare State Exchanges in Midst of Uncertainty as Insurers Prepare to Exit, QHP Certification | HealthCare.com The CheckUp
Image: Ted Eytan / Flickr

Wednesday marks a key deadline for health insurance companies and may signal the future survival or failure of Obamacare state exchanges.

June 21st is the deadline for all health insurance companies to submit initial QHP (Qualified Health Plan) certification applications with full rate table templates. Essentially: by Wednesday, we’ll have a better understanding of rate increases for 2018 and which counties could be without any insurers in the marketplace.

Expect Significant Increases in Premiums

Many early filings indicate significant rate increases. For example, Blue Cross and Blue Shield of North Carolina wants to raise premiums by approximately 23 percent. In Connecticut, Anthem has requested a raise in rates by around 34 percent. CareFirst Blue Cross Blue Shield is hoping to increase rates by 35 percent in Virginia and as much as 59 percent in Maryland.

Several Companies to Pull Out of Obamacare State Exchanges

Other health insurance companies are planning on pulling out of Obamacare state exchanges altogether. Humana announced it will leave Obamacare exchanges in 2018. In May, Aetna decided that it would exit exchanges in Iowa and Virginia. Most significantly, Anthem said it will pull out of Ohio’s exchange and Blue Cross Blue Shield of Kansas City will pull out of Obamacare as well.

The exits of Anthem and BCBS of Kansas City effectively leave 20 counties across Ohio and 25 counties in Missouri without any health insurers in Obamacare state exchanges in 2018. These 45 counties, in addition to two more in Washington, were the only counties projected to be without coverage on the exchanges for the upcoming year. That number, however, may increase depending on Wednesday’s filings.

Some Companies to Continue, Expand Coverage

Not all the insurance companies are retreating from Obamacare exchanges. Centene, for instance, announced that it will expand its coverage in its current markets and enter three new markets starting in 2018. After Aetna, Wellmark, and Medica expressed a desire to leave the Obamacare state exchanges in Iowa, the state requested additional federal funding to save their insurance market and potentially convince Wellmark and Medica to re-enter the exchanges.

The updated map, provided by CMS,  of Obamacare exchanges by county and number of insurers can be seen below.

obamacare state exchanges - projected insurer participation

via CMS

Obamacare’s Future Still Largely Uncertain

The original deadline for QHP rate filings, as proposed by the Obama administration, was May 3rd. The Trump administration pushed that date back to June 21st which health insurance companies hoped would give them a better understanding of Obamacare’s future in Congress and in the courts.

However, as June 21st approaches, Obamacare’s future, legally and legislatively, continues to be unknown. The American Health Care Act (ACHA), which dismantles and reforms much of Obamacare, was initially proposed in the House in March but was not passed until early May when it was finally sent to the Senate. The Senate is hoping to vote on the bill by July 4th but isn’t planning on publicly releasing the details of the law before the vote takes place.

Meanwhile, the Trump administration delayed a decision on whether or not to continue an Obama administration’s appeal of a court ruling that would end cost-sharing reductions (CSR) payments – a key element of Obamacare. According to the Congressional Budget Office (CBO), the CSR payments to health insurers would cost the federal government $10 billion in 2018. Insurance companies need this funding in order to remain in the marketplace, and by extending the May 21st deadline by 90 days, Trump has left insurers unclear as to whether the CSR payments will continue. Without the CSRs many more insurers may pull out of Obamacare.

Republicans, Trump officials and the President himself continue to predict the worst for Obamacare. Trump has said that Obamacare is in a “death spiral,” “failing” and  “essentially dead.” After Wednesday, we should have a better understanding if that dire diagnosis will hold true.

Prepare for Open Enrollment

While there’s still a lot of uncertainty about which health insurance companies will stay and which will leave Obamacare state exchanges, it’s best to be prepared for open enrollment for when the time comes. Read our tips on what you can do now to prepare for the Open Enrollment Period (OEP) coming up November 1st.

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