Obamacare players: the rise and fall of healthcare providers

“The ones that are going to make it and the ones that are going to grow and the ones that are going to make money are the ones that can actually manage the risk”

Obamacare players: the rise and fall of healthcare providers

Life & Health

By Sam Boyer

The Affordable Care Act is contentious for a number of reasons. It’s been praised in certain circles, others say it still needs improvement, still others have called it a disaster.
And on the insurance front, too, it’s been a minefield. The ACA, or Obamacare as it’s known, has been top of the new administration’s hit list, with repeal options tabled but not yet enacted. In recent months, amid the uncertainty and instability of the Act, insurers have been moving in both directions – some pulling out of their ACA offerings, others ramping up their coverage.

While Aetna, Anthem, Humana, and UnitedHealth have all either pared back their coverage or effectively abandoned the ACA, other insurers like Oscar, Centene, and Health Care Service Corp, are increasing their stakes.

So why are some companies increasing their coverage, when the whole ACA may soon cease to exist if the current administration has its way?

“They’re either betting that that’s not going to happen – which seems to be a fair bet, it’s not crazy to think it’s not going to happen – or even if it were to happen, there’s still a lot of people getting covered right now and there’s still going to be a push to try and get people covered one way or the other,” said a health spokesman for the National Association of Insurance Commissioners [NAIC].

“If you’re already in and you’re getting a name for yourself, and you’re getting your networks, there’s always going to be a place for you.”

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Many ACA healthcare insurers have cited large losses as their reason for exiting the program, as have some that are sticking it out. Managed care companies, in particular, who are used to operating within the environment of the ACA, would likely make out the best, the NAIC spokesman said.

“The ones that are going to make it and the ones that are going to grow and the ones that are going to make money are the ones that can actually manage the risk, and manage their cost, and make that happen,” he said.

As to what might transpire with the new administration’s proposed repeal of the ACA, though, is anyone’s guess.

“Especially at this point – the get-votes part of the process – you just don’t know what’s going to happen,” he said.
As it stands in the past few months:

Expanding: Oscar Insurance announced in June plans to begin selling health plans on the Obamacare marketplace in Tennessee in 2018 as well as expanding its offerings in other states. The insurer will expand into new areas of Texas and California, and return to the New Jersey market it earlier dropped.

Meanwhile, Centene also plans a broad expansion of its Obamacare offerings next year with plans to sell ACA plans in three additional states – Kansas, Missouri and Nevada – as well as expanding coverage in six states – Florida, Georgia, Indiana, Ohio, Texas and Washington – where it already offers plans.

Health Care Service Corp has said it intends to sell coverage in Oklahoma, where it is the only insurer on the exchange, as well as in New Mexico and Montana, and Texas and Illinois.

Retreating: In May, Aetna Inc. announced it would leave the few remaining states where it had been selling Obamacare plans next year. The insurer said last year it would pull out of 11 states. Aetna has said it expects to lose more than $200 million on individual health plans this year in the four states where it’s still selling Affordable Care Act plans.

Anthem, one of the nation’s biggest health insurers, said last month it would not return to Ohio’s public insurance exchanges next year, a decision that was predicted would open more holes in the ACA’s increasingly thin system. It later announced a retreat from state-wide coverage in Nevada to just three of the state’s 16 counties. In recent weeks, Anthem has said it’ll also quit Obamacare markets almost entirely in Wisconsin and Indiana.

Anthem has blamed the exits on uncertainty over the future of the health law’s markets, as Republicans in Congress struggle to agree on a way to undo Obamacare. The company still has a larger presence in the ACA than major rivals like Aetna, and also Humana and UnitedHealth Group, which have all largely quit selling Obamacare plans altogether.


Related stories:
Insurer threatens to drop Obamacare “immediately” – 700,000 could be affected
Major insurer plans ACA return

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