Anthem leaving Maine’s ACA marketplace, citing uncertainty

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by Joe Lawlor, Press Herald

Anthem Blue Cross Blue Shield will no longer sell new policies on Maine’s Affordable Care Act health insurance marketplace, citing the 2018 market uncertainty and volatility as the reasons for its withdrawal.

“A stable insurance market is dependent on products that create value for consumers through the broad spreading of risk and a known set of conditions upon which rates can be developed,” Anthem spokesman Colin Manning said in a written statement. “Today, planning and pricing for ACA-compliant health plans has become increasingly difficult.”

He listed the shrinking and deteriorating individual market and continued changes and uncertainty in federal operations, including the future of the cost-sharing reduction program that helps low-income consumers pay premiums. Insurers would have to pay for the reductions if the government stops funding the program.

Anthem has 28,700 customers on the ACA’s individual marketplace, out of more than 80,000 Mainers who obtain insurance on the marketplace. Current Anthem customers can keep their marketplace plans for 2018, according to state law, but would no longer receive the cost-sharing and subsidies that make coverage affordable, meaning most are likely to migrate to other plans.

Anthem’s exit leaves Community Health Options and Harvard Pilgrim Health Care as the only insurers offering plans in which cost-sharing and subsidies can be used to help pay premiums. Most enrollees qualify for the subsidies, which are available to those earning up to 400 percent of the federal poverty level, or $98,400 for a family of four.

Community Health Options, a cooperative that formed in Lewiston as part of the ACA’s efforts to boost choices for customers, indicated it was staying in the Maine marketplace, as did Harvard Pilgrim. Wednesday was the deadline for insurers to sign federal contracts to participate in the 2018 marketplace. CHO has 41,400 enrollees and Harvard Pilgrim has 20,800.

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“Even though there’s one less company, there’s still many plans to choose from,” said Kevin Lewis, president and CEO of Community Health Options. “People can still realize and obtain the kind of coverage that’s right for them.”

Lewis said CHO is “well-positioned” to absorb Anthem’s customers.

Harvard Pilgrim explained its decision to stay in the marketplace in a statement issued Wednesday.

“Current uncertainty in the market makes it difficult for us and other health insurers to plan constructively for the future, and indecision about subsidies for low-income individuals has further complicated matters,” said Ed Kane, Harvard Pilgrim vice president. “However, continuing to offer high-quality, high-value health insurance options that meet the varying needs of Maine residents is consistent with our mission and values.”

ACA UNCERTAINTY

The Trump administration has roiled the 2018 marketplace by refusing to commit to long-term funding of the cost-sharing program. The cost-sharing reductions help people who earn less than 250 percent of the federal poverty level – $61,500 for a family of four – afford insurance. Enrollees are still entitled to the cost-sharing reductions, but insurers would be on the hook to pay them out if the Trump administration stops funding the program.

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Eric Cioppa, Maine’s superintendent of insurance, acknowledged the confusion in the ACA market this year and advised consumers to be vigilant in comparing plans.

“(The turmoil) has resulted in higher rates, and also in fewer choices,” Cioppa said in a written statement. He noted that uncertainty surrounding subsidies means certain plans may have to increase premiums. He advised consumers to call the bureau with questions, or check out resources on its website.

The political battle over the ACA was reflected in several statements issued by political figures after Anthem’s announcement Wednesday, including Reps. Chellie Pingree and Bruce Poliquin and Gov. Paul LePage. Pingree, a Democrat, and Poliquin, a Republican, both called on Congress to put aside partisan differences and work to address problems with the ACA.

LePage, a Republican, described Anthem’s action as the “collapse of Maine’s health insurance marketplace,” and criticized Sens. Susan Collins and Angus King of Maine for refusing to support Republican efforts to repeal and replace the law.

About 90 percent of Mainers with ACA coverage won’t have to pay more for their insurance because they qualify for subsidies, which absorb the premium increases.

Anthem has fully or partially left the ACA individual marketplace in nine out of 13 states where it offers plans. It will offer limited coverage in Maine.

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“Anthem will not sell individual plans on the health insurance exchange in Maine for 2018,” said Manning, the company spokesman. “Additionally, Anthem will reduce its current health plan offerings and offer one off-exchange, gold-level plan that will only be available in Aroostook, Hancock and Washington counties.”

Gold-level plans cannot be purchased with premium subsidies and do not provide cost-sharing reductions to eligible low-income consumers.

The Maine Bureau of Insurance approved double-digit rate increases last month for all three of the state’s providers of health insurance under the ACA – 27.1 percent for Harvard Pilgrim, 17.5 percent for Community Health Options and 18.8 percent for Anthem.

In its June filings, Harvard Pilgrim requested an initial 39.7 percent rate increase that it later lowered to 29.2 percent, Community Health requested a 19.6 percent rate increase and Anthem sought an increase of 21.2 percent.

Manning said that although a number of factors contributed to Anthem’s decision, the rate set by the Maine insurance bureau was not among them.

MARKET DISRUPTIONS

Steve Butterfield, a public policy analyst with Consumers for Affordable Health Care, an Augusta-based advocacy group, said the Trump administration is sabotaging the Affordable Care Act, and Congress has so far not stepped in to help stabilize insurance markets. Butterfield said not only is the cost-sharing reduction funding in danger, but the Trump administration’s lack of enforcement of the individual mandate – which requires that people purchase insurance or pay a penalty – and its cutting of advertising and outreach efforts are undermining the insurance markets. For instance, open enrollment has been cut back from three months to six weeks this year, from Nov. 1 to Dec. 15, and the budget to advertise the enrollment period has been slashed.

“For carriers, who hate any kind of risk, they are seeing the administration being unwilling to support and uphold the law of the land, the ACA,” Butterfield said. “It’s a self-inflicted wound.”

David Clough, Maine state director of the National Federation of Independent Business, said “the Anthem announcement will be very disruptive to affected Maine small-business owners and their employees. The announcement will create stress and send them scrambling for affordable alternatives.”

He noted that many small-business owners purchase individual insurance on the marketplace, and small businesses historically have had difficulty affording insurance for their employees.

Anthem did not close the door on returning to the Maine marketplace if conditions stabilize. There are proposals in Congress to mandate that the cost-sharing reduction funding be paid to insurers, and other measures to stabilize the marketplace. Collins, a Republican, is on the Senate committee that was mulling bipartisan fixes to the ACA. Those discussions were shelved when it seemed like ACA repeal was moving forward.

“They were nearing agreement on the first bill that would have helped lower increases in premiums and stabilize the insurance market to provide people with more choices. It’s unfortunate that those talks were put on hold, and they should resume without delay,” said Annie Clark, Collins’ spokeswoman. Collins also has sponsored a bill with Sen. Bill Nelson, D-Florida, that would shore up ACA insurance markets.

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Poliquin, R-2nd District, said in a written statement that the ACA needs a solution.

“We need a fix, and the first place to accomplish that is going to be in the Senate,” said Poliquin, who voted to repeal the ACA in May. “Insurers like Anthem have continuously warned that they would pull out of the marketplace if nothing was done to fix the serious flaws in the Obamacare law, and Anthem has specifically cited support for legislation in Congress to do so.”

HEALTH CARE ACTIONS IN CONGRESS

Anthem supported portions of the House bill that would have repealed the ACA, but opposed Graham-Cassidy, the Senate repeal bill that failed this week. Collins’ opposition to Graham-Cassidy put the final nail in the coffin for 2017 attempts to repeal the ACA.

Pingree, D-1st District, blamed the Trump administration for the ACA’s instability.

“The Trump administration has chosen to undermine our current health care system and Mainers will be harmed,” Pingree said in a written statement. “I have long advocated for Congress to pass bipartisan fixes to the Affordable Care Act. Instead, Republican leadership has spent the year pushing disastrous ACA repeal plans that would throw millions off of health insurance. We now see that inaction in Congress along with the extreme actions of the Trump administration have resulted in fewer options for Mainers instead of more affordable, quality health care.”