Bucking Trump, Health Insurers Expand Obamacare Footprints

Donald Trump along with heads of state hosted by the NATO Secretary General on 11 July 2018. (Photo: Sadak souici / Barcroft Media via Getty Images)

Undaunted by the latest attacks on Obamacare – both verbal and financial from the Trump administration – health insurance companies are forging ahead with expansion plans in the business of providing individual health coverage to Americans under the Affordable Care Act.

Take Bright Health, a startup, that said it would launch an array of new health insurance products in the government health insurance business, including new markets for individual plans under the ACA. Other insurers yet to announce Obamacare expansions are expected to do so in the next month when they report their second-quarter earnings.

“We think the basic policy issue is that, while there will be debate on aspects of how health coverage is provided to individuals at both federal and state levels, families need affordable health coverage,” Bright Health CEO Bob Sheehy said. “Healthcare is always evolving; we have navigated a multitude of changes and have always adapted to them with success.”

Bright, a privately held startup, is among several health insurance companies including various Blue Cross and Blue Shield plans and publicly traded insurers like Centene that are looking into new markets in the ACA’s individual health insurance business. Meanwhile, other health insurers like Wellmark Blue Cross and Blue Shield of Iowa are returning to the individual insurance business under the ACA for 2019, the insurer has said.

Bright Health will enter Arizona and Tennessee with individual plans in 2019 on the ACA’s public exchanges after already selling ACA-compliant policies in Colorado and Alabama this year.

For some of these expanding plans, they are forming closer ties with locally-based medical care providers rather than launching broad networks of doctors and hospitals that doomed some of the earlier efforts to offer individual coverage on the ACA’s public exchanges.

Plans like Oscar Health, Bright Health and Centene are expanding at a time larger players like Aetna , Humana and UnitedHealth Group have moved on from Obamacare and related individual health insurance businesses. The larger players are scaling back or leaving the individual business after being unable to successfully manage the costs of sick patients signing up for coverage.

Those expanding say they have a different strategy. “In our discussions with potential care partners, we’ve found they are eager to engage with us to ensure access to affordable care for their patients so we see a lot of opportunity out there despite an uncertainty that might exist,” Sheehy said of the doctors and hospitals Bright Health works with in the locales where they sell health insurance. “Our Care Partner Health Plan model is such that it’s flexible enough to adapt to the shifting regulatory environment at both the federal and state levels.”

Privately held startup Oscar has established some notable relationships with medical care providers in the Obamacare markets it has entered. This year, for example, Oscar began to offer co-branded individual insurance in Ohio with the Cleveland Clinic in five northeastern counties in that state.  Oscar Health has said it will sell health insurance in six new markets, an aggressive expansion for 2019 despite continued regulatory changes by the Trump administration and the almost constant threats by the Republican-led Congress to repeal the ACA. “Oscar remains committed and excited to bring Oscar to six new markets in 2019,” Oscar spokeswoman Emma Riccardi said.

The latest regulatory change came last weekend when Seema Verma, the Trump-appointed head of the Centers for Medicare & Medicaid Services decided to suspend the risk adjustment program, citing a New Mexico federal court ruling that said a formula used to calculate the risk adjustment payments was flawed.

The individual market has also been hit by verbal political attacks from President Trump who boasted at one of his political rallies last month that Obamacare was “essentially gutted.”

Trump, Verma and the Republican-led Congress have certainly made changes that have unsettled the individual insurance market, adding uncertainty to rules and regulations. They’ve also opening the door to skimpier health plans that don’t cover as much and could draw healthy patients away from ACA-compliant plans with richer benefit packages.

But the moves by the Trump administration and Verma have contributed to higher cost health plans that, in turn, made health insurers more profitable while jacking up premiums for taxpayers and Americans who don’t qualify for the ACA’s subsidies. “The announcement is likely to drive a meaningful increase in premiums given the repeal of the Individual mandate compounds the uncertainty,” Ana Gupte, healthcare analyst for Leerink Partners said in a report this week referring to Verma’s decision to suspend risk adjustment payments.

Source: https://www.forbes.com/sites/brucejapsen/2018/07/12/bucking-trump-health-insurers-expand-obamacare-footprints/

« »