Insurers move to stem ACA losses--but at expense of consumers?

Seeking to lessen their financial losses on Affordable Care Act exchange products, health insurers have started to discourage consumers from signing up for coverage outside of standard enrollment periods and choosing less-profitable plans, Kaiser Health News reports.

Large insurers including UnitedHealth, Humana, Anthem and Cigna have indicated in recent months that they are concerned about the sustainability of their individual market plans. United, in particular, has threatened to pull out of the exchanges entirely in 2017 if its margins do not improve. And Aetna CEO Mark Bertolini said on a recent call with investors that "we continue to have serious concerns about the sustainability of the public exchanges."

Among the issues cited by insurers is misuse of special enrollment periods. Consumers who sign up during the SEPs--which are only supposed to be used for qualifying life events such getting married--typically are more costly to insure, the companies say, in part because some of these individuals use SEPs to sign up for insurance when they get sick. In response to these concerns, the Centers for Medicare & Medicaid Services has outlined tighter restrictions for SEP enrollment.

But insurers are also are taking measures to lessen SEP sign-ups. Anthem, Aetna and Cigna in recent days have told brokers they will stop paying them commissions to sign up more customers any time other than the standard enrollment periods, KHN reports.

Along similar lines, Cigna and Humana have stopped paying brokers to sell gold-level exchange plans that offer higher benefits but are less profitable for insurers that sell them. These types of plans typically enroll sicker members, the article notes.

Insurers and their trade association--America's Health Insurance Plans--say these "necessary changes to coverage and benefits" are an attempt to adjust to market realities, including unexpectedly high medical claims and shortfalls in the risk-corridor program, according to KHN. But some experts see these moves as a violation of the principles of the ACA.

"The only explanation I can see for them doing this is risk avoidance--and that is discriminatory marketing and not permitted," Timothy Jost, a Washington and Lee University professor and health policy expert, tells the publication.

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