With time running out to set insurance prices and still no sign of whether the Trump administration will continue funding cost-sharing subsidies for low-income Americans, several states are giving health insurers a little more wiggle room to file 2018 rates.
State insurance regulators hope an extra few weeks to price plans will be enough to ease the insurance industry's jitters created by efforts to repeal and replace the Affordable Care Act and keep insurers from bailing on the exchanges.
Colorado, New Hampshire, Oregon and Kentucky have extended deadlines for insurers to submit rates for 2018 Affordable Care Act health plans.
Colorado pushed the deadline to mid-June from May 15 to file rates for the individual market, where 400,000 individuals access coverage. That will allow more time for congressional lawmakers to provide a clear regulatory framework and for insurers to adapt their plans to the new rules, Colorado Insurance Commissioner Marguerite Salazar said.
"In years past we've been able to stick with our deadlines," she said, but given the uncertainty this year, "we're going to be as flexible as possible."
Oregon this week pushed its deadline to May 15 from the first of the month "to give the carriers more time given the uncertainty," a spokeswoman for the state's Department of Consumer and Business Services said.
New Hampshire moved its deadline from April 24 to June 2. A spokeswoman for the state's insurance department said the extra time is meant to allow insurers to react to the CMS' market stabilization rule finalized earlier this month.
And a spokeswoman for Kentucky's insurance department said moving the state's deadline from May 17 to June 7 will give insurers more time to gather early 2017 enrollment and claims data needed to price next year's plans.
Still, several other states including Virginia, Maryland, California and Connecticut, must file rates the first week of May. Insurers use these rates to calculate plan premiums. The ACA requires states to review the rates and health insurers to justify rate hikes of 10% or more. The HHS handles rate review for three states: Oklahoma, Texas and Wyoming.
The Trump administration in February extended the federal deadline to file 2018 exchange plan applications and rates to June 21. Initially, insurers had until May 3. It was a small gesture meant to give insurers more time to decide whether to sell exchange plan in 2018. But insurers said it did nothing to resolve the uncertainty surrounding the long-term stability of the individual market.
Health insurers have been anxious about pricing 2018 plans without knowing whether certain ACA fixtures will remain next year. They say they need to know if the Trump administration will enforce the mandate requiring most people to enroll in coverage, and fund the subsidies that lower the cost of insurance for most marketplace enrollees.
"What the issuers are most concerned about is not having the CSRs paid for, and so they are trying to get some type of reassurance or commitment or at least a good indication about where the administration stands on supporting those," said Kevin Counihan, the former CEO of HealthCare.gov, the federal insurance marketplace.
Without a sign, health insurers likely will either increase premiums to hedge against the risk of regulatory changes, or they will quit offering exchange coverage altogether.
Some insurers may even file two sets of rates—one that assumes regulations will remain the same, and another "worst case" filing that will protect the insurer if the cost-sharing subsidies aren't funded, said David Anderson, a researcher at the Margolis Center for Health Policy at Duke University.
The worst-case filing could include rate hikes of 40% to 50%, he said.
The Alliance of Community Health Plans, a group that represents regional not-for-profit health plans, estimated that premiums would increase by as much as 20% in some areas if cost-sharing subsidies were eliminated.
Some insurers have threatened to pull out of the individual market for 2018 if a clear regulatory framework doesn't emerge soon. National insurers Aetna, Humana and UnitedHealth Group have already scaled back participation or exited the exchanges completely. Other insurers, like Anthem, Cigna Corp. and Molina Healthcare, have been reluctant to commit.
While Colorado's Salazar said none of the state's seven marketplace insurers have threatened to drop out in 2018, "they have told us that if the subsidies go way, they don't see how they can continue in the individual market."
At least two states are facing the possibility that some counties will have no insurers next year. In Iowa, Wellmark Blue Cross and Blue Shield and Aetna announced this month they will stop selling ACA-compliant plans in the state in 2018. That makes Minnesota-based Medica the only insurer in most Iowa counties, and it hasn't yet decided whether to continue selling plans.
Meanwhile, 16 counties in Tennessee are facing having no insurance options next year after Humana announced it would exit the market. About 50,000 people are enrolled in marketplace coverage in those counties.
There's no fix to that unprecedented situation, Counihan said. He added,"If there were any other options, nobody told us about it."
There was a close call in 2016 when one Arizona county with 10,000 insurance customers facing having zero insurers, but Counihan's team was able to coax Blue Cross Blue Shield of Arizona, which had dropped out of the market, to commit to selling plans again.
"In the vast majority of cases, the insurers want to stay," he said. "They just don't see a path forward, so you have to work with them to find it."
In places with no health insurers to sell exchange coverage, consumers wouldn't be able to access financial assistance that lowers the cost of insurance.
"Consumers need to have this coverage to avail themselves of the tax credits and cost sharing reduction subsidies," Counihan said. "It behooves anybody to make sure there's coverage there."
