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Insurers and ACA Marketplaces Over Time

Posted by Laura McMullen on Thu, Jun 15, 2017

We’re approaching CMS’ June 21 deadline for Qualified Health Plan applications and rate table templates for plans to be sold on or the state marketplaces. So, it seems like a good time to look back over the last four years and see how the mix of insurers participating in the exchanges changed between 2014 and 2017.

ACA.pngThe Kaiser Family Foundation’s Health Reform blog has a nice summary here that includes interactive maps. Data for this analysis was gathered from, state exchange enrollment websites, and insurer rate filings to state regulators.

Year by year overview

  • 2014: on average 5 insurers participated in each state, ranging from 1 insurer in New Hampshire and West Virginia to 16 in New York.
  • 2015: on average 6 insurers participated in each state, ranging from 1 in West Virginia to 16 in New York.
  • 2016: on average 5.6 insurers participated in each state, ranging from 1 in Wyoming to 16 in Texas and Wisconsin. The mix of carriers in each state changed a lot in 2016 as CO-OPs failed and new plans entered the market.
  • 2017: on average 4.3 insurers participated in each state, ranging from 1 in Alabama, Alaska, Oklahoma, South Carolina and Wyoming to 15 in Wisconsin.

Other findings from the analysis

  • There are fewer choices in most counties. In 2017, 58% of enrollees (living in about 30% of counties) had a choice of three or more insurers, compared to 85% of enrollees (living in about 63% of counties) in 2016.
  • Rural areas have fewer insurers than metro areas. In 2017, metro areas have 2.5 insurers vs. 2 insurers in rural areas. 87% of 2017 enrollees live in metro areas.
  • Many counties are served by one carrier, most likely a Blue Cross Blue Shield or Anthem plan. In 2017, about 21% of enrollees (living in 33% of counties) have access to just one insurer on the marketplace (up from 2% of enrollees living in 7% of counties in 2016).

How has the mix of insurers impacted your network? Has your network participation in the ACA changed over the last four years?

Tags: health insurance, Affordable Care Act, ACA. healthcare exchanges, Healthcare, ACA, health insurance co-ops

Carrier Offerings on the Exchanges and Employer Preferences in the Commercial Group Market

Posted by Laura McMullen on Fri, Jul 08, 2016

We’re reading about carrier offerings and costs on public exchanges and employer preferences in the commercial group market. Here’s a roundup of interesting datapoints, perspectives, and news.

Health insurers are announcing their intentions for the 2016-17 open enrollment period:

And requesting rate increases:

  • Credit Suisse reports that 20.7% is the average increase in the price of plans that will be sold in 2017 through public exchanges. (AIS Health Business Daily, 6/22/16, From INSIDE HEALTH INSURANCE EXCHANGES)
  • Arizona Blue has requested a rate increase of 65.9% and will be the only exchange option in every county in the state. Phoenix Health Plans requested a rate increase of 60.4%. (Arizona Republic, 6/13/16)
  • Louisiana Blue Cross Blue Shield requested rate increases ranging from 20.5% to 28.3% on average for the various plans offered on the exchanges. Their plans cover about 70% of the people in the individual market in that state. It’s (New Orleans Times-Picayune, 6/6/16)

Employers are still offering health insurance to their employees: "Everyone thought [the Affordable Care Act] was the curtain call for small businesses...that they would just drop off coverage and send their folks to the exchanges. We haven't seen that happen. In fact, we've seen a bit of resurgence in small group in the last several months and are growing slightly in terms of overall membership." — Brian Cheney, divisional vice president of small business at Health Care Service Corp., which operates Blues plans in five states, told The AIS Report on Blue Cross and Blue Shield Plans*.*. (AIS Health Business Daily, 7/6/16, Click here to read the THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS* article in which this quote appeared — "Death of the Small-Group Market Has Been Greatly Exaggerated, Blues Plans Say" Free for THE AIS REPORT subscribers; $17 for non-subscribers.) * Not affiliated with the Blue Cross and Blue Shield Association or its member companies. (AIS Health Business Daily, 7/6/16)

And they see opportunities to make improvements for their employees:

  • “Employers are doubling down on opportunities to impact health care quality and costs at the source — by working more closely with high-performing providers through select networks and providing better information to help employees make higher-value health care choices,” stated a report by the Pacific Business Group on Health (PBGH) for the American Health Policy Institute (AHPI). (AIS Health Business Daily, 6/16/16)
  • 85% ... of employers that evaluated private health insurance exchanges opted to not move forward, with the main reason being unproven cost savings. About half were also concerned about employee disruption, according to employer surveys by Chicago-based Pacific Resources Benefits Advisers, LLC. (AIS Health Business Daily, 6/23/16, From INSIDE HEALTH INSURANCE EXCHANGES "Private Exchanges Are Evolving, But Firms May Lack Motive to Adapt”)

How are these trends playing out in your market? Are these rate increases an opportunity for you? What about the employer interest in high-performing networks?

Tags: ACA. healthcare exchanges, ACA, HIX

Impact of Health Plan Participation on the Exchanges

Posted by Susan Donegan on Fri, Apr 22, 2016

We’re reading about changes to health plan participation on the exchanges and the impact on the industry for insurers and consumers. Here’s a roundup of interesting datapoints, perspectives, and news.

UnitedHealth Group, said Tuesday that in 2017 it will exit most of the 34 states where it offers plans on the Affordable Care Act insurance exchanges. UnitedHealth plans to withdraw from health insurance marketplaces in Arkansas, Michigan, Connecticut and parts of Georgia. "We will be down to a handful of states that we will be actively participating in the exchanges," Stephen J. Hemsley, chief executive officer of UnitedHealth Group said in an earnings call, noting that the small market size and greater expense of patients insured through the marketplaces led the insurer to make the decision. (The Washington Post, 4/19/16)

A new report finds if UnitedHealth pulled out of the exchanges entirely, the impact on prices and competition would be modest. Industry observers wonder whether United backing off is a signal of the first defection among major insurers, or a reflection of the company’s business strategy. “United has always been tepid about these markets,” said Leemore Dafny, an economist at the Kellogg School of Management at Northwestern. “They were slow to get in and they are fast to get out.” (Marketplace, 4/19/16)

59% ... of the potential market for public exchange enrollment has been signed up by the 10 best-performing states, leaving "little potential for growth in these states," according to a new report from the Kaiser Family Foundation. (AIS Health Business Daily, 4/6/16, Click here to read the HEALTH PLAN WEEK article in which this datapoint appeared — "New Report: States With the Highest ACA Enrollment May Be Tapped Out" Free for HPW subscribers; $17 for non-subscribers).

Amid calls for more regulation triggered by narrowing health plan networks, three states in particular are scoring "victories" in the push to improve network adequacy and provider directories, according to consumer advocacy organization Families USA. Not all are convinced, however, that narrow networks adversely impact consumers. An executive from BlueCross BlueShield of Tennessee has argued that creating more focused networks helps keep down costs for consumers and insurers. (FierceHealthPayer, 4/8/16)

Industry leaders are focusing on three strategies key to long-term sustainability for the ACA Exchanges. Tackling the challenges of ACA exchanges is difficult, but the plans that figure it out have 17 million new customers to serve. Designing narrow networks, enhancing patient engagement and exercising value management are critical to success. (HIT Consultant, 4/19/16)

22% ... higher medical costs were needed in 2015 to care for public exchange enrollees compared to employer-based group members, up from 19% higher in 2014, according to a report released March 30 by the Blue Cross Blue Shield Association. (AIS Health Business Daily, 4/7/2016, Click here to read the INSIDE HEALTH INSURANCE EXCHANGES E-ALERT in which this datapoint appeared. Free for HEX subscribers; $17 for non-subscribers).

Tags: ACA. healthcare exchanges, ACA, HIX

Open Enrollment Coming to a Close

Posted by Susan Donegan on Fri, Jan 29, 2016

Open Enrollment ends in two days. Here is the latest news and findings about the exchanges.

The U.S. government will limit a process that allowed people to sign up for health insurance under Obamacare outside of the normal enrollment period, after health insurers complained that the special sign-up windows were letting people into the program only when they got sick. (Bloomberg Business, 1/19/16)

According to the latest Gallup/Healthways survey, the rate of uninsured Americans has fallen from 18% in 2013 to 11.9% exiting 2015. It's the young and lower-income minorities who have seen the biggest benefit of healthcare reform, and that's presenting a unique set of challenges for insurance companies participating in the Obamacare exchanges. (The Motley Fool, 1/17/16)

"From an employer perspective, one of the interesting things about the Cadillac tax being delayed for a couple of years is we are now going to see a lot of companies moving to full replacement, high-deductible plans in 2017. [In the] plan design survey [conducted by the National Business Group on Health this year we had something like 27% of companies considering moving to a full replacement high-deductible plan for 2017, really in anticipation of the Cadillac tax going into effect. But with a two-year delay I think we are going to see that level off.... [Employers] will look at ACOs, performance networks and centers of excellence and try to understand how these delivery models can perform versus the market from a cost, an outcomes and a patient experience perspective. And I would say that ACOs in particular are not very well understood." — Brian Marcotte, president and CEO of NBGH, told AIS's Health Plan Week. (AIS Health Business Daily, 1/22/16 Click here to read the HEALTH PLAN WEEK article in which this quote appeared — "2016 Outlook: 'Turning Point' Year to Give More Answers On ACA Exchanges, Networks and Politics" Free for HPW subscribers; $17 for non-subscribers)

Thirty-five percent more people than last year have enrolled for their employer-sponsored healthcare benefits on private online marketplaces, according to a new report from global consulting and technology firm Accenture. "We're also beginning to see larger employers taking a wait-and-see approach," said Scott Brown, managing director at Accenture Health, explaining that these employers continue to look for ways to contain their costs. He believes that wait-and-see approach is responsible for the lower than anticipated growth in private exchange business. (Healthcare IT News, 1/20/16)

“United is a huge health insurer, and the exchanges remain a relatively small market, so there are very few insurers in which the exchange is going to be make or break for their whole book of business,” said Caroline Pearson, Ann Arbor, Michigan-based senior vice president and health reform practice leader at health care consultant Avalere Health. “I do not think we're seeing the beginning of the fall of the market,” Ms. Pearson said. “We are seeing a correction that may cause rates to go up to cover the costs.” (Business Insurance, 1/20/2016)

89% ... of the counties in the U.S. have Blue Cross and Blue Shield products sold on public exchanges, according to the Blue Cross and Blue Shield Association. (AIS Health Business Daily, 1/25, Click here to read the INSIDE HEALTH INSURANCE EXCHANGES E-ALERT in which this datapoint appeared. Free for HEX subscribers; $17 for non-subscribers).

Anthem Inc. said its individual exchange health plans weighed on fourth-quarter profit, causing it to miss analysts' expectations. Nearly 800,000 people enrolled in Anthem plans through the exchanges, about 30 percent below its expectations. Anthem said net profit fell to $180.9 million, or 68 cents per share, in the fourth quarter, from $506.7 million, or $1.80 per share, a year earlier. (Reuters, 1/27/16)


Tags: ACA. healthcare exchanges, ACA, HIX


Posted by Susan Donegan on Fri, Jan 15, 2016

We’re continuing to read about plan changes, network changes, and price changes. Here’s a roundup of interesting datapoints, perspectives, and news.

The momentum of open enrollment continued to wind down, with growth of less than 75,000 consumers in week 10, from January 3 to January 9, 2016. (Healthcare Finance, 1/13/16)

The administration’s “special enrollment” categories have allowed people to wait until they become ill or need medical services to sign up, driving up costs broadly, insurers told federal health officials. “Individuals enrolled through special enrollment periods are utilizing up to 55 percent more services than their open enrollment counterparts” who sign up in the regular period, the Blue Cross and Blue Shield Association, told the administration. (The New York Times, 1/9/16)

Health insurers in the Affordable Care Act exchanges will see changes from the CMS this year to strengthen the market, including eliminating special enrollment periods and an early look at plans' risk-adjustment data, the top CMS official said on Monday. (Modern Healthcare, 1/12/16)

"We believe it is incredibly important, in the business we're in, that we insure all Americans," Chief Executive Mark Bertolini said. "We believe we have an obligation to stick it out and work with it until we know that it won't work. And I believe it is too early to give up on this process." (Business Insurance, 1/13/16)

About 11.3 million Americans have signed up so far for individual health insurance in 2016 through and the state-based exchanges, the U.S. government said on Thursday. The U.S. Department of Health and Human Services said that total included about 4 million people under age 35. (Reuters, 1/7/16).

8% ... was the average increase in annual deductibles for in-network services from 2015 to 2016 for insurers on public exchanges, according to an analysis of data contained in AIS's new online database Rx Benefit Data. (AIS Health Business Daily, 1/11/16)

About 1.4 million households that got financial help for health insurance under President Barack Obama's law failed to properly account for it on their tax returns last year, putting their subsidies at risk if they want to keep coverage. (The Charlotte Observer, 1/8/16)

Several states are making changes to their ACA programs:

Louisiana's new Democratic governor, John Bel Edwards, said in his inaugural address that he will spend his first day in office taking steps to expand Medicaid eligibility under the Affordable Care Act.(The Times-Picayune, 1/11/16)

Following through on a campaign pledge, Gov. Matt Bevin has notified federal authorities he plans to dismantle kynect, Kentucky's health insurance exchange created under the Affordable Care Act. (Courier-Journal, 1/11/16)

Arkansas Gov. Asa Hutchinson has told federal officials he wants to impose new limits on the state's hybrid Medicaid expansion that's providing coverage to more than 200,000 people.(KATV-TV Little Rock/The Associated Press, 1/4/16)

Tags: ACA. healthcare exchanges, ACA, HIX

Mergers, Tiered Plans, Premium Costs, and Enrollment Numbers for the ACA in 2016

Posted by Susan Donegan on Fri, Jan 08, 2016

We’re continuing to read about plan changes, network changes, and price changes. Here’s a roundup of interesting datapoints, perspectives, and news.

$904 ... Is the premium rate for the highest-cost individual silver public exchange plan in the U.S. for 2016, an Alaska marketplace plan offered by Premera Blue Cross. Molina Healthcare, Inc. in New Mexico offers the country's lowest-cost silver plan, at $180.81. From AIS's Health Insurance Exchange Database: 2016 Plans and Premiums (AIS Health Business Daily, 12/21/15). Monthly premiums for the lowest-cost silver plans for a 40-year-old on a public exchange offered by BCBS affiliates in 2016 range from $809 (Premera Blue Cross in AK) to $211 (Highmark Blue Cross Blue Shield) in PA. (AIS Health Business Daily, 1/7/16, reprinted from the AIS Blue Cross Blue Shield report, subscription required)

$695 ... will be the penalty in 2016 for adults without health insurance, with a $347.50 fine for each child, to a max of $2,085 per family, or 2.5% of family income in excess of the 2015 income tax filings thresholds ($10,300 for a single person and $20,600 for a family), according to a recent Kaiser Family Foundation analysis. From HEALTH PLAN WEEK (AIS Health Business Daily 12/22/15) Many people are paying the penalty instead of buying health insurance. (NYT (subscription required), 1/3/2016)

The fight over Horizon Blue Cross Blue Shield of New Jersey’s new OMNIA health plan reached a fever pitch after state Senate Democrats on Dec. 7 introduced a quartet of bills in the legislature that would restrict or delay the plan’s implementation. One of the bills would impose a moratorium on new tiered plans introduced in 2015 until Jan. 1, 2017, and allow consumers who have already chosen a tiered plan the option of selecting another. The uproar in NJ “could be a harbinger of things to come on the national stage” said Mike Mascolo, New Jersey-based employee benefits national practice resource leader for Wells Fargo Insurance Services. (AIS Health Business Daily, 12/29/15)

The healthcare sector is an enduring topic of political and economic discussion in America. That was true in 2015 and will continue to be so in 2016. Here are some key story lines: Obamacare continued to mature, but its role is still evolving; Medicaid is still advancing, if slowly; Drug pricing is moving to center stage; Merger mania is sweeping the hospital and insurance sectors; Customers are shifting their attention from premiums to deductibles and copays, and insurers are testing new cost-sharing designs. (Los Angeles Times, 12/25/15)

2016 will likely go down as the year of the mega-merger. Aetna Inc. is poised to acquire Humana Inc. Anthem, Inc. intends to take over Cigna Corp., and Health Net, Inc. may become part of Centene Corp. The newly merged Goliaths will have unprecedented scale, which will allow them to dramatically reduce overhead expenses and hold down coverage costs. To compete, smaller carriers may need to outsource back-office operations to a third-party vendor or shipping back-office functions to another carrier to reduce selling, general and administrative (SG&A) expenses. (AIS Health Business Daily, 1/5/16)

Since the Nov. 1 open enrollment period began, more than 8.5 million consumers either signed up for health coverage through or had their existing coverage automatically renewed, according to the Centers for Medicare and Medicaid Services. (Healthcare Finance, 12/30/15)Not only is overall enrollment up significantly, enrollment by people 18-34 years old has almost doubled. (The Motley Fool, 1/2/16)


Tags: ACA. healthcare exchanges, ACA, HIX

ACA Enrollment Deadline Extended, Changes for 2016, And the Senate Vote

Posted by Susan Donegan on Fri, Dec 18, 2015

We’re continuing to read about plan changes, network changes, and price changes. Here’s a roundup of interesting datapoints, perspectives, and news.

52-47 ... was the vote of the U.S. Senate on Dec. 3 to repeal core components of the Affordable Care Act — including elimination of the federal government's authority to run public exchanges and provide subsidies — marking the first time the Senate has been able to pass such legislation. President Obama has promised to veto the measure. (AIS Health Business Daily, 12/11/15) (Click here to read the INSIDE HEALTH INSURANCE EXCHANGES E-ALERT in which this datapoint appeared. Free for HEX subscribers; $17 for non-subscribers).

Federal officials late Tuesday extended the deadline for consumers to sign up for health insurance on the federal site until 11:59 PM Dec. 17 due to "unprecedented demand." "Hundreds of thousands have already selected plans over the last two days and approximately 1 million consumers have left their contact information to hold their place in line," CEO Kevin Counihan (USA Today, 12/15/15)

ACA changes for 2016. The Kaiser Family Foundation analyzed the price movement of benchmark plans (i.e., the second-lowest cost silver plan before tax credits) in 49 major cities across the U.S., encompassing all but one state, and discovered that benchmark premiums were expected to rise by 10.1% in 2016. Consumers not receiving financial assistance may have difficulty absorbing such a large increase. Employers with 50 or more full-time-equivalent employees will be required to offer health coverage, and potentially subsidize that coverage, for eligible employees. Failing to do so could entail fines of as much as $3,000 per worker for businesses. (The Motley Fool, 12/12/15)

U.S. Senator Richard Blumenthal (D-CT) wrote the top executives of UnitedHealth Group, asking them to reconsider a possible decision to stop offering plans under the ACA as early as 2017. His request comes about a month after CEO Stephen Hemsley told investors that UnitedHealth Group expected to lose $650 million this year and next year from its 550,000 customers served through health care exchanges under Obamacare. Blumenthal said some of the challenges that UnitedHealth has pointed out, such as customers signing up for a policy to cover a planned medical expense and then quitting, are short-term issues that can be overcome as more people sign up for the exchanges. (Hartford Courant, 12/16/15)

"We continue to forecast that the 30 Not-for-Profit [NFP] Blue Cross plans, in aggregate, will lose money for full-year 2015 (i.e., net income including investment income), which would be the first full-year loss for the Blues since the industry down-cycle of the late 1980s. With the ACA exchange losses as a key driver, we estimate the NFP Blues aggregate after-tax income (including investment income) was $464 million for the first nine months of 2015, down more than 70% year-on-year from the same period in 2014, implying a margin of 0.4% versus year-ago 1.6% and as compared to 3.6% on average for the same periods of 2010-2013." — Matthew Borsch, securities analyst for Goldman, Sachs and Co., said in a Dec. 3 update, based on 3rd quarter financials filed with the National Assn. of Insurance Commissioners. (AIS Health Business Daily, 12/18/15) (Click here to read the HEALTH PLAN WEEK article in which this quote appeared — "ACA Markets May Not Be in Death Spiral, But Pain Is Being Felt Across the Industry" (Free for HPW subscribers; $17 for non-subscribers).

Clear Choices, an advocate for the Council for Affordable Health Coverage (CAHC), shopped on 12 state-based exchanges and to grade them on a variety of factors. Kentucky's exchange, Kynect, came out the winner with an 84 out of 100, while New York State of Health scored lowest. Exchange websites that scored well allow consumers to enter very specific information and the site sorts it in ways that allow them to make better choices about their health plans, CAHC President Joel White said on a call to discuss the findings. "Details matter, and our individual circumstances matter a great deal" when it comes to healthcare, he said. (Fierce Health Payer, 12/11/15)

Tags: ACA. healthcare exchanges, ACA, HIX




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