Insurers offer early signs of 2018 ObamaCare plans
Anthem Inc. made preliminary filings indicating it will offer plans on the Affordable Care Act marketplaces in Virginia and Kentucky next year, providing an early signal on the insurer’s exchange business.
Cigna Corp. and Aetna Inc., which like Anthem have said they are reconsidering their exchange offerings, are among the insurers that made similar filings in Virginia. But one current Virginia ACA insurer, UnitedHealth Group Inc., didn’t file 2018 forms, and a spokesman confirmed it would leave the state’s marketplace next year.
The filings represent early moves toward offering plans on those states’ exchanges, but the insurers could reverse course in coming weeks or months, and their strategy may be different in other states. The early disclosures also don’t include details such as rates and the regions where they intend to participate.
Insurers are currently struggling to make decisions about their 2018 exchange offerings, amid what they have complained are mixed signals from the Trump administration and congressional Republicans about the future of the ACA. In particular, the insurers want guarantees that they will continue to receive federal payments that help cover the cost of care for lower-income ACA exchange enrollees. Without these payments, industry officials have said the exchanges may see significant rate increases and pullbacks.
President Donald Trump has threatened to stop funding the ACA’s cost-sharing reduction subsidies, which help lower-income ACA enrollees with expenses such as deductibles, in an effort to prod Democrats to negotiate over a health bill. A White House spokesman said earlier this week that the ACA is “already collapsing on its own” and the president will work with Congress on replacement legislation.
Virginia and Kentucky have some of the earliest filing deadlines among state regulators. Virginia has a policy of quickly making the forms public. The Kentucky Department of Insurance disclosed 2018 filing information in response to a public records request.
Virginia may not be indicative of broader trends. Its marketplace has eight insurers offering exchange plans in 2017, according to health-care research nonprofit Kaiser Family Foundation, and it was one of the few states to retain robust offerings from national insurers.
UnitedHealth, which this year withdrew from all but a handful of states’ ACA marketplaces, declined to comment on future plans for its other remaining states. The UnitedHealth spokesman said its decision about 2018 ACA marketplace plans in Virginia “in no way impacts our small and large group businesses, or Medicare or Medicaid programs in the Commonwealth.”
Anthem, which is a major exchange insurer in 14 states where it is a Blue Cross Blue Shield licensee, is being closely watched by government officials and investors as it makes decisions about 2018. The company has said it is considering pulling back if the business isn’t stabilizing. Anthem’s final decisions in Virginia and Kentucky will be important because it is the only exchange insurer in 28 Virginia counties and 59 Kentucky counties, according to the Kaiser data. An Anthem spokeswoman declined to comment.
Aetna, which pulled out of most of its state exchanges this year, has already announced that it will leave at least one more state, Iowa, in 2018. Aetna also sells exchange plans in Delaware and Nebraska. A spokesman said that the company will participate in the filing process in Virginia, but “no final decisions have been made due to continued uncertainty and financial risk,” and added that the insurer had “no update at this time on our potential presence in other states.”
Cigna offers exchange plans in seven states. A Cigna spokesman said final plan decisions typically occur in the third quarter of the year, and “we will continue to assess our participation based on the evolving rules, regulations and design of the marketplace throughout this process.”
In Kentucky, CareSource, a nonprofit, also made a preliminary filing to offer exchange plans for 2018. A CareSource executive said it intends to file rates in the four states where it offers exchange plans, but its final decisions depend on what happens with the cost-sharing payments. Another Kentucky exchange insurer, Humana Inc., previously announced it is pulling out of all exchanges next year.
Other insurers including CareFirst BlueCross BlueShield also filed to offer exchange plans in Virginia. A CareFirst spokesman said it intends to offer the 2018 plans and keep the same service area as this year.