HCSC has begun working through the regulatory process that would allow it to participate next year in the ACA exchanges in the five states its Blue Cross subsidiaries cover. A final decision about whether to participate won't come until the fall, when final rates are due. If the subsidies are not funded then, insurers might increase prices by 20%, according to a study by the Kaiser Family Foundation.
"We hope to once again participate in the individual market, and are working with regulators at the state and federal levels to achieve a stable, sustainable market," an HCSC spokeswoman says via email.
The potential threats to Illinois Medicaid pose another layer of uncertainty for Blue Cross here.
Though HCSC makes most of its money from employer and individual plans, it nonetheless benefited from Illinois' expansion of coverage for the poor and disabled. Of the five state Blue Cross plans that make up the insurance giant—Illinois, Montana, New Mexico, Oklahoma and Texas—all but Oklahoma's participate in Medicaid, but Illinois provides almost all of the business.
Illinois' Department of Healthcare & Family Services, which administers the state's Medicaid program, says it paid Blue Cross about $1.4 billion so far in fiscal 2017, which concludes at the end of this month.
During the 2016 calendar year, HCSC as a whole pulled in $1.4 billion from Medicaid payments, or less than 5% of its overall premium revenue. Still, Illinois' program expansion doubled that figure from 2015, when HCSC received $717 million from Medicaid.
Even though Blue Cross is not as exposed to Medicaid as other insurers, any rollback of the program stands to hurt it in another way.
"If you have folks who no longer qualify (for Medicaid), the only ones who are going to show up for the individual market are the sick ones," Starc, the Kellogg professor, says.