PA Payer Market Stable, but OH Loses ACA Exchange Participants
Pennsylvania will see a full return of existing payers and a below average rate increase, while Ohio braces for 20 unserved counties after Anthem exits the ACA exchange.
Source: Thinkstock
By - Pennsylvania and Ohio are having very different experiences with their Affordable Care Act health insurance exchanges as they move into 2018.
While Pennsylvania’s existing five payers will continue to offer exchange plans at roughly the same prices in 2018 for all 67 counties, Ohio will have 20 counties without a payer option after Anthem announced that it will no longer offer products in the state.
The rates filed with the Pennsylvania insurance commission show an average premium increase of 8.8 percent for individual plans and 6.6 for small group plans. This is well below the national average rate increase of 22 percent.
“These low percentages show that Pennsylvania’s market is stabilizing and insurers are better understanding the markets and the population they serve,” said Pennsylvania Insurance Commissioner Teresa Miller.
Miller indicated that if the individual mandate is repealed, residents could see statewide premium increases of 23.3 percent. Furthermore, if cost-sharing reductions (CSRs) were not paid to insurers, rate increases could shoot up 20.3 percent statewide.
If both the individual mandate and CSRs were eliminated, insurers in the state estimated a rate increase of 36.3 percent.
Over 500,000 Pennsylvanian’s receive insurance from the Affordable Care Act (ACA) exchanges. In 2016, 76 percent of those who purchased health insurance from the marketplace qualified for premium assistance.
“Information provided by insurers shows the extent to which instability and changes would impact Pennsylvania’s 2018 health insurance rates. This proves what we already know – instability caused by adverse action from the federal government will do nothing but hurt consumers who are stuck in the middle,” said Commissioner Miller.
It is that instability in federal regulation which has led Anthem to announce it is exiting Ohio’s health insurance exchange for 2018.
The move will leave at least 20 counties in the Buckeye state without an insurer offering plans on the marketplace exchange. There were 67,000 people in Ohio covered under Anthem plans.
Anthem cited the usual suspects listed by payers for leaving the health insurance exchanges: uncertainty of cost sharing reduction (CSR) payments, possible loosening of individual mandate regulations, and rising healthcare costs.
“Planning and pricing for ACA-compliant health plans has become increasingly difficult due to the shrinking individual market as well as continual changes in federal operations, rules and guidance,” said Anthem in a statement.
The insurer will maintain an off-exchange plan in one county, a legal placeholder which will allow them to reenter the Ohio marketplace in 2019 or later if they choose to.
Ohio has a federally-facilitated exchange, which had 11 payers in the marketplace for 2017.
Anthem has filed rates in several other states, but has not indicated whether it will back out of those exchanges at this time.
“This is a problem not just in Ohio but across the country. Approximately one-third of the counties around the United States now only have one insurer, and more and more counties are seeing their last insurer leave just like those in Ohio,” said Ohio Sen. Rob Portman (R) in a statement released just after Anthem announced its departure.
With continued political uncertainty over CSRs and federal healthcare regulation, the question of insurer participation in state exchanges or the extent of their premium increases is nowhere close to being resolved. As rate increases by payers are in the approval process by state insurance commissions, the option for payers to leave state exchanges for 2018 remains open.
