- Questions over the future of the Affordable Care Act (ACA) and its cost-sharing reduction (CSR) payments have prompted many payers to abandon ACA state health insurance exchanges in part or entirely in 2017.
Insurers cited the usual suspects as reasons for their marketplace withdrawal, which will take effect in 2018: regulatory instability, lower-than-expected enrollment numbers, large pools of high-cost beneficiaries, possible changes to or elimination of the individual mandate, and structural issues within the exchange itself.
This exodus of payers will leave many Americans with empty health insurance marketplaces, or with just one option to choose.
Marketplaces that lack robust payer participation also negatively impact consumers. A recent Black Book survey found that 58 percent of consumers believe their coverage has worsened due to the mass exodus of payers from the market.
As payers make tough decisions in an extremely uncertain political and financial environment, the state-level insurance exchanges will continue to evolve.
Here is a list, updated frequently, of the major payers that have decided not to participate in the ACA state health insurance exchanges past 2017.
May 11, 2017: Aetna announced it would be leaving the Nebraska and Delaware ACA health insurance exchanges, completing its retreat from the entire 2018 national marketplace. The company made announcements earlier in 2017 that it would be leaving the Virginia and Iowa ACA marketplace for 2018.
"Our individual Commercial products lost nearly $700 million between 2014 and 2016, and are projected to lose more than $200 million in 2017 despite a significant reduction in membership,” said Aetna spokesperson TJ Crawford in an email. “We will not offer on-or off-exchange individual plans in Delaware or Nebraska for 2018, and at this time have completely exited the exchanges."
Aetna’s commitment to participating in the exchanges has long been questioned. After a January 2017 court decision blocked the Humana merger, the judge in his opinion concluded that Aetna’s withdrawal from the ACA marketplace was a reaction to the federal antitrust suit.
June 6, 2017 - Anthem cited instability with federal regulation as the primary reason it will exit Ohio’s health insurance exchange for 2018.
The exit by Anthem will leave at least 20 counties in the Buckeye state without a single coverage option on the exchange. More than 10,500 people will lose their coverage.
“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.
Anthem has filed rate requests to offer marketplace plans in 14 other states, but has not indicated whether it will back out of those exchanges at this time.
Blue Cross Blue Shield of KC
May 30, 2017 - Blue Cross and Blue Shield of Kansas City has decided to stop selling coverage in 32 counties across Kansas and Missouri. Citing a $100 million financial loss in 2016, the payer stated that staying in the state exchange environment is not a viable business option.
“Since 2014, we’ve expended significant resources to offer individual ACA plans to increase access to quality healthcare coverage for the Kansas City community,” said Danette Wilson, President and CEO of Blue KC. “We have a responsibility to our members and the greater community to remain stable and secure, and the uncertain direction of this market is a barrier to our continued participation.”
The decision will affect around 67,000 members and will leave a number of counties in the region without any ACA exchange coverage options.
February 16, 2017 - Humana will discontinue all sales nationwide of individual health insurance plans through the ACA’s exchanges for 2018. The move will leave more than 150,000 Humana customers without a health insurance carrier.
“We are again seeing signs of an unbalanced risk pool based on the results of the 2017 open enrollment period,” CEO Bruce Broussard said in an investor call. “Therefore we’ve decided we can’t continue to offer this coverage in 2018.”
Humana was expected to lose up to $45 million in the ACA health insurance exchanges and forecasted continued losses while participating in the marketplace.
Humana’s decision to exit the ACA exchanges came quickly after federal courts blocked its proposed merger with Aetna.
Wellmark Blue Cross Blue Shield
April 05, 2017 - Wellmark Blue Cross Blue Shield, which operates in Iowa and South Dakota, will not renew or sell individual plans on the Affordable Care Act health insurance exchanges effective Jan 1, 2018.
The decision follows three-year losses of approximately $90 million and increased premium prices of individual health plans governed by the ACA.
“No one really benefits from rising costs. While there are many potential solutions, the timing and relative impact of those solutions is currently unclear. This makes it difficult to establish plans for 2018,” said Wellmark Chairman and CEO John Forsyth.
Wellmark’s exit from the ACA exchanges affects 21,400 Iowans, or 1.3 percent of Wellmark’s 1.66 million members in Iowa.