Healthcare Business News

Reform Update: Insurance exchange enrollments top 900,000 at WellPoint, Humana, Aetna

By Paul Demko
Posted: February 6, 2014 - 3:30 pm ET

More than 900,000 people have chosen plans offered by three of the country's largest publicly traded insurers—WellPoint, Humana and Aetna—through the state and federal exchanges.

WellPoint leads the way with more than 500,000 enrollments. Both Humana and Aetna are reporting about 200,000 signups. UnitedHealthcareUnitedHealthcare, the largest of the pack, is offering plans in fewer markets than those peers and did not disclose an enrollment figure along with its most recent earnings.

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All of the numbers should be taken with a caveat: Some of those consumers have not made their first premium payment and therefore aren't officially enrolled. But it provides a snapshot of what share of the emerging individual market is being captured by the major publicly traded firms. The CMS officials announced Jan. 24 that 3 million individuals had selected coverage through the state and federal exchanges.

Aetna was the latest to provide some insight into enrollments during a call with investors Thursday. Roughly two thirds of the 200,000 enrollees have made their initial payments, according to company officials. But for individuals who signed up before Jan. 1, that figure is closer to 90%.

Aetna CEO Mark Bertolini indicated that it's too early to determine how the company will proceed in offering products on the exchanges for 2015 coverage. The deadline for submitting plans to be sold during the 2015 open enrollment period is expected to be June 27, according to a recent letter from the CMS.

“We know the information and the questions we need to answer before we can be comfortable with the rates that we will submit,” Bertolini said. “It's way too early to tell because we have very little information. The demographics are about where we thought they would be, a little skewed to higher cost individuals.”

But Bertolini downplayed the importance of the exchanges to Aetna's overall book of business. He pointed out that the individual market currently accounts for only 3% of the company's revenues and 1% of profits. “We expect the business to lose money in the first year,” he said.

Bertolini also indicated that back-end accounting functions for the federal exchange remain inoperable and that that's a major concern moving forward. But with the overall functionality of the federal exchange improving dramatically since December, considerable attention has turned to the adequacy of provider networks.

Legislation pending in several states would push insurers to include more providers in their networks, and hospitals in Washington and Kentucky have complained about being shut out of important plans. The CMS issued guidance this week indicating that it will have tougher network adequacy rules in place for plans offered through the exchanges during the 2015 open enrollment period.

Bertolini suggested that “doc shock” will be a major issue moving forward. “I think we're going to hear a lot about this over the next six months,” he said. “We do pay a lot of attention to it because it does impact pricing.”

1.1 million to 1.8 million new Medicaid enrollees, according to Avalere Health

The Patient Protection and Affordable Care Act has resulted in 1.1 million to 1.8 million new Medicaid enrollees, according to an analysis by Avalere Health. That's a fraction of the 6.3 million enrollments reported by the CMS since Oct. 1, when the state and federal exchanges opened for business. Roughly three quarters of the new Medicaid enrollees are in states that have opted to expand coverage to individuals who make up to 138% of the federal poverty threshold. About half of the states have opted to move forward with Medicaid expansion. Overall, enrollment grew by 12%, with a 19% uptick in expansion states, according to the Avalere Health analysis.

Legislators seek increase to income levels for insurance subsidies

Two California Democrats want to allow individuals with higher incomes to qualify for insurance subsidies if they live in more expensive parts of the country. Currently, the subsidies are available to those making up to 400% of the federal poverty threshold—$45,960 for individuals and $94,200 for a family of four. But under legislation introduced by Reps. Anna Eshoo and Mike Thompson, those caps would rise significantly for residents of areas with a higher cost of living. For instance, in the San Francisco-Oakland area, individuals earning up to $61,356 would qualify for subsidies.

Extension considered for individual insurance policies

The Obama administration is considering an extension of the president's decision to let people keep their individual insurance policies even if they are not compliant with the healthcare overhaul, according to the Associated Press.

The AP reports that Avalere Health CEO Dan Mendelson said he has had informal discussions with administration officials suggesting they may let policyholders keep that coverage for another three years, though he stressed that no decision has been made.

Follow Paul Demko on Twitter: @MHpdemko

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