In June 2017, the Centers for Medicare and Medicaid Services (CMS) released a map showing marketplace health insurance coverage for the United States. The map painted a grim picture of healthcare options for as many as 47 counties in the country that would be in danger of having no insurance providers in the ACA marketplaces for 2018. Without an insurance company in those areas, over 35,000 people could have been left without health insurance or federal subsidies that help low-income Americans purchase insurance.
On August 24, the Ohio Department of Insurance confirmed that the final county without an insurer would have a carrier after all. CareSource agreed to provide coverage to citizens of Paulding County, Ohio. CareSource is just one of several health insurance companies that have stepped up to cover areas that were without coverage when other major medical insurance companies chose not to offer plans for the coming year.
CareSource is already offering plans on the exchange in Ohio. According to Pamela Morris, CEO of CareSource, the decision to offer coverage speaks to the company’s commitment to the marketplace as well as their mission to serve those who are in need of coverage. CareSource agreed to offer on-exchange insurance in Paulding County, believed to be the last “bare” county in the country, despite the lack of long-term guarantee from the Trump administration that cost-sharing reductions for subscribers would be paid.
In August, Centene agreed to provide coverage to the 14 bare counties in Nevada. The company has been responsible for providing coverage to more than 40 bare counties, including 25 in Missouri. Their agreement to cover Nevada guaranteed at least one on-exchange insurance option for more than 8,000 people in the state who may not have had any options without Centene’s intervention. Garrett Leaf, President of Centene, said that the company looks forward to expanding their product offerings to the health insurance marketplace in 2018.
In addition to Centene and CareSource, other insurers have stepped up to offer coverage in bare counties. Iowa, a state that had several counties without coverage, will now have full coverage after Medica stepped up to offer marketplace plans. However, Medica has also requested a rate hike of 43.5 percent, a rate increase that will not impact those who receive subsidies provided under the Affordable Care Act (ACA). Those who do not qualify for the subsidies could see a significant increase in health insurance costs.
Uncertainty Beyond 2018
Although many are calling this a win for the ACA, a law that many Republicans claimed would implode under weighty regulations, insurers are still cautious regarding what may happen after 2018. Even for this year, increases in premiums could be significant as uncertainty remains over cost-sharing reduction payments (CSRs). Premium price hikes range from 8 to 60 percent. President Trump has yet to announce whether he will continue making CSR payments after this year. Critical payments to insurers have helped companies keep premiums down, particularly for low-income customers.
Even with the subsidies, rates will be higher as fewer young, healthy people are purchasing policies. Many consumers are under the impression that the individual mandate that requires them to have health insurance will not be enforced, despite the fact that the IRS says it will continue to enforce the law.
Several insurance companies have stepped up to the plate to provide coverage to the bare counties that existed earlier in the summer. It is still a question whether premiums will remain affordable in those areas, or whether insurance companies will be forced to raise costs significantly in order to accommodate financial losses and the lack of young people willing to sign up for coverage.