Something will have to change to make the marketplaces financially sustainable for health insurers. The Hill cites data from McKinsey & Co. that shows payers with plans in the individual market, which includes ACA marketplaces, recorded losses in 41 states in 2014.
Aetna CEO Mark Bertolini expressed serious concerns about the ACA exchanges in February, in particular that the risk pools have been sicker and costlier than expected, according to the report. Even so, Mr. Bertolini said it is too soon to give up on the process.
UnitedHealth Group, which is the largest insurer in the nation, has provided a more dismal outlook of the public exchanges. It warned of potential departure from state marketplaces last November and recently pulled out of Arkansas’ and Georgia’s exchanges.
However, The Hill reported that HHS said UnitedHealth plans are inconsequential on the marketplaces compared to Blue Cross Blue Shield plans, which make up the bulk of the offerings. BCBS has dropped participation in New Mexico and its North Carolina branch has considered dropping out as well if the situation doesn’t improve over time.
Mandy Cohen, MD, COO of CMS, told The Hill it is unlikely BCBS will leave the North Carolina marketplace, since most of its recent challenges stem from internal operations issues, not the marketplaces or risk pool. Dr. Cohen also told The Hill she is confident the marketplaces are not trapped in a death spiral, primarily because increasing enrollment will stabilize the market.
The largest issue will actually be in the political sphere, according to the report. With payers pushing for premium increases, Republicans could argue the ACA isn’t working, presenting an issue for Democrats this election cycle.
More articles on payer issues:
Mountain States Health Alliance to shut down health plan
Humana’s wellness and rewards program rebrands as Go365: 5 things to know
Blue Cross Blue Shield of Texas threatens to drop HCA facilities
