With ACA in flux, state insurance regulators aim for flexibility

Document titled, Affordable Care Act
Not only is policy uncertainty complicating insurers’ decision about whether to participate in the ACA exchanges next year, but it’s also hampering their ability to file accurate rates. (Getty/Designer491)

Recognizing that health insurers are leery about selling plans on the Affordable Care Act exchanges next year, some state insurance commissioners are stepping in to provide as much flexibility—and reassurance—as they can.

Washington state’s Insurance Commissioner Mike Kreidler, for example, is considering following Alaska’s lead and creating a state-based reinsurance program, according to The Hill. He is also considering measures to entice insurers to sell plans in rural counties, but acknowledged there’s nothing he can do if companies want to exit.

“The GOP is scaring the bejesus out of them, and I’m trying to calm things down and work it out,” he told the publication.

Former Healthcare.gov CEO Kevin Counihan, who personally stepped in to prevent a county from having no exchange insurer last year, added that state insurance commissioners will now largely be charged with this role given the Trump administration’s stance on the ACA.

Indeed, having some areas go without an ACA exchange insurer next year is a very real concern. For example, Blue Cross and Blue Shield of Kansas City’s decision to exit a 32-county service area in 2018 will leave 19,000 people with no exchange plan choices unless another insurer steps in.

Nationwide, the average number of insurance companies per state dropped from 5.6 in 2016 to 4.3 in 2017, according to new data from the Kaiser Family Foundation. Four states—Alabama, Alaska, Oklahoma, South Carolina and Wyoming—had only one company selling plans this year.

Not only is policy uncertainty complicating insurers’ decision about whether to participate in the exchanges next year, but it’s also hampering their ability to file accurate rates. Several so far have hedged their bets and requested double-digit increases.

In California, Insurance Commissioner Dave Jones is adapting by allowing insurers to file two sets of rates—one for if ACA provisions like cost-sharing reduction payments and the individual mandate continue, and one for the event they don’t, The Hill article noted.