Even though it’s only the beginning of 2015, insurers are already starting to think about 2016 rate filings. Using 2014-2015 Health Insurance Marketplace data, we looked for correlations between silver plan premiums and variables like the number of carriers and plans in a rating area, available industry metrics, and the structure of provider networks in each rating area. We focused our analysis on the second-lowest silver plan offered in each market and discovered some interesting findings.
Blue Cross and Blue Shield of NC posts first loss in 15 years | The Charlotte Observer The Charlotte ObserverFebruary 28, 2015
Blue Cross and Blue Shield, the state’s largest health insurer, said Friday that it posted its first financial loss in 15 years as a result of insuring high numbers of older and sicker people under the Patient Protection and Affordable Care Act.
The Chapel Hill organization signed up 257,704 people under the federal health care law, which requires insurers to provide coverage regardless of a customer’s health condition.
New enrollees last year swelled Blue Cross’s covered membership to 3.91 million people, and boosted revenue by 25 percent to an all-time high of $8 billion.
But steep medical claims – for hip and knee replacements, heart procedures, specialty drugs and other costs – drove up medical claims from $5 billion in 2013 to $6.4 billion in 2014. Blue Cross also paid $156 million in ACA-related fees, a new cost for the company.
Implementing Health Reform: Beginning The Cadillac Tax Regulatory Conversation And Other ACA News – Health Affairs BlogFebruary 24, 2015
An amendment to the 2015 federal budget continuing appropriation raises a question: Will insurers receive their full 2014 risk corridor payments?
What’s the issue?
The risk corridor program created by the Affordable Care Act (ACA) has proven to be one of the most controversial aspects of the health care law. Questions have been raised about the source of payments, whether the Department of Health and Human Services (HHS) has the authority to make payments under the program, and whether the program is required to be budget neutral.
In response to questions from the Government Accountability Office (GAO) on its budget authority for risk corridor payments, HHS cited section 1342 of the ACA, which establishes the risk corridor program and requires HHS to collect payments from and make payments to certain qualified health plans. HHS says that the fees collected and the payments made under the risk corridor program are consistent with the definition of user fees.
The fiscal year 2014 appropriation gives the Centers for Medicare and Medicaid Services (CMS) the authority to collect user fees and keep the fees available for use through the 2019 fiscal year. HHS states that this appropriation along with section 1342 gives CMS the authority to collect and distribute risk corridor payments. In an opinion issued September 2014, the GAO agreed that payments collected under the risk corridor program are “properly characterized as user fees.”
via Health Policy Briefs.
But Obamacare asserts tight regulation over the annual premium increases that insurers can take, nationalizing that process. Now premium increases aren’t reported on a state-by-state basis, but closely watched as a national standard.
That turns the industry’s rate cycle into a closely watched political event. It will require a rotating roster of cause célèbre to give reason to premium hikes — politicizing that process. This will put insurers at odds with the products and services they purchase on behalf of their customers. To keep their hands cleaner, individual health plans will wage these national fights through their Washington trade association.
These premium decisions were once local events, swayed by economic factors that were particular to each state. We’re already seeing that these rate cycles will be increasingly noisy, and national, adding to the political scrutiny. Insurers need politically minded arguments that can resonate across different markets – and most of all, resound in Washington. This year, a new cure for hepatitis C became the justification.
CoOportunity’s many customers needed more medical care than expected, according to Nick Gerhart, Iowa’s insurance commissioner, and it had priced its plans too low. After taking control of the co-op in late December, Mr. Gerhart decided last month that it could not be saved and asked a court to liquidate it. The co-op, he said at the time, faced more than $150 million in liabilities. That left its customers scrambling for new coverage, and providers wondering if millions of dollars in outstanding claims would ever get paid.
More broadly, it raised the question of whether one of the Affordable Care Act’s biggest experiments in holding down insurance costs was in trouble beyond Iowa and Nebraska. The co-ops, which the law says must be “consumer governed” by boards elected by their customers, have received nearly $2 billion in federal loans, including $145 million that went to CoOportunity. They were initially supposed to receive $6 billion over time, but Congress later slashed the amount and virtually no funds remain….
A recent analysis by the A. M. Best Company, an insurance rating agency, found that all but one of the co-ops reported financial losses through the third quarter of last year. Some analysts say that it is too early to predict the long-term viability of the co-ops, and that first-year losses were expected. But for now, the losses indicate that many were paying more in insurance claims and other expenses than they were receiving in premiums, a problem that seems to have hurt CoOportunity more than the others.
Under the Affordable Care Act, states with fewer insurers have higher insurance premiums than states with more insurers. This expected feature of a competitive market has not been studied within states, however. We tested the hypothesis that insurance premiums decrease in more competitive geographic rating areas within states in the U.S.A.
This cross-sectional study utilized publicly
available premiums from the Federal Health Insurance Exchange website,www.healthcare.gov. Univariate and multivariate analyses were used to modelpremiums based on the number of insurers in geographic rating areas. The relationship between premiums and the number of insurers competing in a geographic rating area was also calculated for each unique insurance plan offered on the exchange. The data set and statistical code used for this research is linked in the publication. We found that there was an unexpected,marginally positive relationship between average monthly premiums and thenumber of insurers in a geographic rating area (+$5.71 in monthly premiumsper additional insurer, p<0.001). We also found that identical plans tend to be offered with marginally higher premiums in rating areas with more insurers(+$3.18 in monthly premiums per additional insurer, p=0.002), contrary to the relationship we expected from a competitive marketplace. The principal limitation of the study is that this unexpected relationship, which suggests alack of competitiveness of this early market, could be due to unobserved/confounding factors that influence pricing in more competitive rating areas.
On the Federal Health Insurance Exchange, the price of insurance is higher in more competitive rating areas within states. This may be explained by lack of competition in this early stage market.