BCBSNC announces it is considering dropping ACA plans next year.

[Taxman59]

Just heard that Blue Cross is looking at getting out of the ACA next year, joining UnitedHealthcare. I chose BCBSNC since it was more likely to be there next year. If both of the big provides are out of ACA plans, who will the insurance be issued by? What is happening in other states ?


Have the day you deserve, and let Karma sort it out.

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[MBSC]

If both of the big providers are out of ACA plans, who will the insurance be issued by?

Aetna or Humana could fill the ACA gap. If not, off-exchange plans would still be available. However, some may...

A move by Blue Cross to stop offering federally subsidized policies would force more than 300,000 North Carolina residents to try other insurers, if they still offer ACA coverage, or revert to being uninsured. A withdrawal by Blue Cross would be acutely felt, as it’s the only insurer under the ACA that offers coverage in all 100 counties in the state.

Wilson said the size of the rate increase approved this fall by the N.C. Department of Insurance for next year would likely determine Blue Cross’s ACA strategy. He said the company will have to assess whether the rate increase the agency approves “makes sense” for the company.

Reference: Blue Cross CEO says insurer may leave ACA market in NC in 2017 | News & Observer

As for that Humana option:

Humana has said its participation in Affordable Care Act public exchanges next year is uncertain...

Reference: http://ifawebnews.com/2016/02/11/humana-considers-leaving-obamacare-exchanges-as-profits-fall/

 

[RockyMtn]

Could be posturing for a bigger rate increase.

 

[Gone4Good]

Rut Roh.

Is that just a rumor or is there an actual report?

 

[Midpack]

Rut Roh.

Is that just a rumor or is there an actual report?

There are several reports, here's one http://www.bizjournals.com/triad/ne...-blue-shield-chief-insurer-may-leave-aca.html

The underlying numbers I read in another report were pretty awful in terms of costs

The bad news was the reason. BCBSNC lost $400 million on ACA policies in 2014 and 2015. In 2014, BCBSNC sustained $123 million in losses following receipt of $343 million in reinsurance and other federal subsidies provided through the ACA. The kickbacks available for 2015 are not expected to cover much of the loss. The insurer had previously announced rate hikes for 2016 policyholders averaging 32.5 percent to help cover future losses.

BCBSNC claims data for 2014 and the first half of this year revealed some key trends that are driving up health care costs:
More chronic illness and a higher-than-expected demand for expensive health care services among ACA customers. Health care spending among ACA customers increased each month, up 30% in January through June of this year compared to the first six months of 2014.
A 27% increase in the number of emergency department visits in January through June of this year compared to the same period of 2014. Many of these were for conditions that could have been better treated in a different, less expensive care setting, like urgent care.
Soaring prescription drug costs among our ACA customers. Drug spending increased 33% in the first half of this year compared to January through June of 2014. This makes prescription drugs the fastest-growing component of medical spending in our ACA business.
ACA customers dropping coverage or stopping premium payments. Most of those who dropped their coverage first used expensive medical services. The others who cancelled their plans were among the healthiest customers, those who had not filed any claims. Without the right balance of healthy and sick customers, we would not be able to continue covering the cost of care at current premium rates.

But I don't live in NC...

 

[MichaelB]

There's no announcement to BCBS NC customers on their website. When the CEO announces like this something to the media, he may have regulators or policy makers in mind as the primary audience.

The NC Insurance Regulator has a lot to do this year. Hope he gets the job done, eh?

 

[LARS]

Can you spell Single Payer system... (is that a flying Porky the Pig I see).


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[MichaelB]

Yoda would say, "not go there, lets .. eh?"

 

[LARS]

Yoda would say, "not go there, lets .. eh?"

In all truth, I wasn't trying to introduce politics, but the thought that what other solution is there if the law mandates insurance, but insurers don't want/can't afford to offer insurance. Just a big stinking mess...


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[Fermion]

Why does a discussion of single payer mean porky cometh?

It might be time the USA joins first world nations.

 

[REWahoo]

Why does a discussion of single payer mean porky cometh?

It might be time the USA joins first world nations.

You answered your own question.

 

[CRLLS]

Why don't the insurance companies just price the ACA policy where they need to be to make a reasonable profit and let the market determine their participation in any given state? BCBSIL killed my high deductible PPO policy this year. I had no help from them in 2015 for hospitals or drugs. no reason IMO to remove that plan. Their recommended HMO policy for 2016 had virtually no coverage at all for local hospitals nor our current doctors. 2, count them 2 urologists in the HMO plan for the entire state of Illinois! I went elsewhere. I would consider them again if they had reasonable coverage, even if priced slightly above the competition. in 2 years we will both be on Medicare. BCBS has already been at the house to push their Medigap plans. That coverage is MUCHO better.

 

[MichaelB]

Why does a discussion of single payer mean porky cometh?

It might be time the USA joins first world nations.

Because the thread topic is BCBS in North Carolina and a press report. If you want to disuss single payer, you're free to start a new thread in the Politics Forum here and adhere to the posting guidelines of that forum.

 

[2017ish]

Why don't the insurance companies just price the ACA policy where they need to be to make a reasonable profit and let the market determine their participation in any given state? ....

Insurance, particularly health insurance, has not been a free market for many years. States and now the feds mandate what must be covered. Companies cannot just set their prices, which are subject to approval by state insurance commissioner (I suspect in all states, but will say "in most"). The commissioner can raise or lower the requested amount. (In Tennessee, the 2016 rate requests were adjusted substantially up in one instance--the ACA Coop that subsequently went out of business). The insurers submit voluminous data in support of their requests....

[Out of consideration for porky, deleted my thoughts on what insurance I would like to buy!]

 

[UtahSkier]

Why don't the insurance companies just price the ACA policy where they need to be to make a reasonable profit and let the market determine their participation in any given state?.

United Health tried to do just that. But the state regulator turned down their 20% rate increase request. The reason given was because of certain revenue sharing activities that didn't happen when other plan provider dropped out. United Health's plan was then underpriced and they lost a bunch of money.

The other issue is the death spiral; A plan that is priced too high will cause only the most desperate (most expensive) people to join. The relatively healthy people will drop out (pay the penalty or get a job with a healthier risk pool). As healthy people drop out of the plan, the plan becomes more expensive. The process repeats every enrollment period.

United Health, Aetna and now BCBS are complaining and threatening to drop out. We may be watching the death spiral scenario play out.

 

[FUEGO]

As a NC resident recently signed up for a gold-plated silver plan through Unitedhealthcare, I'm not too worried. If BCBS and Unitedhealthcare drop out, I'll be going to Aetna which has a perfectly acceptable plan in my zip code ($0 deductible works for me! ). I actually hate them the least of the three big insurers.

As for BCBSNC's comments, I smell some posturing. Hey Mr. Regulator, throw us a bone and we won't leave you high and dry. Of course the regulator could also play hardball and say "take all policyholders or leave all" and make approval for non-ACA policy rates more difficult.

From an economic standpoint, I'm shocked that no one can make a profit with hundreds of billions of dollars of government money sloshing around via subsidies. Maybe we'll see some new market participants or new (to most) care models (Kaiser-ish?? snigle pyaer?).

The huge increase in healthcare consumption in 2015 will also likely reach a steady state as people who never had decent coverage pre-ACA and now have coverage get all of their deferred maintenance taken care of. I know we have a few things we'll get checked out shortly after our UHC policy takes effect (hard to resist with a $0 deductible ). We're coming from a $3000 or $5000 (can't recall) high deductible plan where we hardly ever spend anything at the doc to a world of nearly free medical care. But in 2017, we won't have any deferred maintenance to catch up on.

 

[sengsational]

Could be posturing for a bigger rate increase.

I'd take even odds that's all it is. I predict there will be as many insurers in NC next year as this year.

Meanwhile, I'm trying to cost BCBSNC as much as I can with appeals (overhead), since they tried to "save money" at my expense by not paying for legit preventive labs. I kicked BCBSNC to the curb this year, but UHC doesn't appear, at first look, to be doing much better.

PS: I didn't know there were so many NC'ers here!

 

[modhatter]

All the reasons listed above by BCBS are reasons for advocating a single payer system, where everyone is in and cost of insurance is paid through your taxes.

Many of the problems listed could be curtailed with adequate time.

#1. Drug prices are going nuts, and without some cost containment put in place (As all other countries do.), I see no stopping them. Pharmaceutical companies enjoy the highest earnings of all industries and are spending 7x the cost of R&D, for advertising. Pay attention to your tv commercials and adds in magazines.

#2. People can't just elect when they want insurance and when they don't. It needs to be a constant factor for all, so it is not abused and cost is spread out among everyone..

#3. Over use of emergency rooms needs to carry a penalty when used inappropriately (when Urgent Care Centers are open)

#4. Everyone agrees I believe that there has been a back log of individuals who could not afford insurance before or worked for companies that did not provide insurance, or just didn't want it. It still remains a moral question as to whether you feel that these people should not have access to health care.

We have experienced the same thing in Nevada that you are in N. Carolina. My son first purchased a plan through the new Nevada Co-op. That went belly up after the first year. Then the following year, he purchase a PPO plan through Aetna (only PPO offered) and they pulled out of the market last year too. So this year, he had to purchase a really crumby BCBS plan (highest cost one) that has the worst provider network imaginable. I mean it is really pathetic. Excludes local hospitals, has only three oncologist, a handful of GP's. Before purchasing it though, we looked at plans outside of the Exchange, and they were the same plans offered on the Exchange with the same limited networks, only for higher cost.

So any self employed person having to buy into the individual market here has terrible choices. Wasn't good before, but admittedly it's worse now.
It's a real national crises that must be addressed. (without leaving out part of the population)

 

[FUEGO]

I'd take even odds that's all it is. I predict there will be as many insurers in NC next year as this year.

Meanwhile, I'm trying to cost BCBSNC as much as I can with appeals (overhead), since they tried to "save money" at my expense by not paying for legit preventive labs. I kicked BCBSNC to the curb this year, but UHC doesn't appear, at first look, to be doing much better.

UHC is equally fun. Still appealing the $59 administration of the Hep A immunization they denied as not being preventative.

I'm with you on that bet. Wouldn't be surprised to see 3+ insurers next year.

 

[Gone4Good]

Why does a discussion of single payer mean porky cometh?

Because it will happen when pigs fly?

(Just a joke. Nothing to see here. Move along. )

 

[pb4uski]

One thing to keep in mind is that by and large, increasing health insurance premiums are just reflecting increasing health care costs as insurers are required to spend at least 80% of premiums on claims (if it is less then they must refund any excess premium) so the amount available to cover overhead, taxes and profit is at MOST 20% of premiums.

 

[NW-Bound]

One thing to keep in mind is that by and large, increasing health insurance premiums are just reflecting increasing health care costs as insurers are required to spend at least 80% of premiums on claims (if it is less then they must refund any excess premium) so the amount available to cover overhead, taxes and profit is at MOST 20% of premiums.

+1

Health insures are no saints, but how do we expect them to operate with a loss?

And even if they worked for no wages and even paid for their operating costs out of their pocket, all their clients get extra would be that 20% of premium. Do we bet that some other entities will step up to replace the current private insurers and do that?

The problem with US health care is cost control, which is lacking. It's not about who's paying (it's always the patient who pays, one way or the other). It's how much is being paid, and for what.

 

[travelover]

.............The problem with US health care is cost control, which is lacking. It's not about who's paying (it's always the patient who pays, one way or the other). It's how much is being paid, and for what.

True, but that is way too complicated to really wrap our heads around and doesn't make much of a sound bite.

 

[Senator]

Whenever you are relying on others to provide something, it is a risk. Social Security, pensions, the stock market, etc. Companies have to make money or they go broke. When they do, others take their place.

This is just one additional risk in FIRE. It could have been a different healthcare insurer, or more than one.

If BSBC is not there, you can buy from someone else, move to different state, look for other forms of assistance, or continue working until medicare, like many people.

The real world is not always pretty. Typically there are other options.

There is an old saying "To rely on others is to be disappointed".

 

[ziggy29]

One thing to keep in mind is that by and large, increasing health insurance premiums are just reflecting increasing health care costs as insurers are required to spend at least 80% of premiums on claims (if it is less then they must refund any excess premium) so the amount available to cover overhead, taxes and profit is at MOST 20% of premiums.

True. I wonder how much of this is a shell game, though, in terms of finding creative accounting ways to shift profits from one line of business to another in order to look like they are in compliance with this. I don't know how actively ACA and other federal and state laws "police" this, but many times you can make the numbers say almost anything you want them to say with good accountants and good lawyers.