Blue Cross Blue Shield insurers reaped billions from last year's tax overhaul and many say they plan to use the savings to lower premiums.
However, another component of the overhaul will make that difficult.
Thirteen BCBS health insurers saved a total of $2.3 billion in taxes last year alone as a result of the Republican tax law, which cut the corporate tax rate from 35% to 21%, according to an analysis by A.M. Best.
Health Care Service Corporation was the biggest winner among the Blues and raked in $1.1 billion in savings followed by BCBS Michigan at $358 million. New Jersey-based Horizon Healthcare Services also saw more than $300 million in savings.
Many insurers said they plan to use their tax savings to reduce exchange premiums and increase customer benefits.
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For example, BCBS Vermont said it is passing 100% of federal tax savings onto customers, and Premera announced it will spend $250 million over the next five years to help stabilize the individual market.
However, any lowered premiums as a result of the tax cuts will be heavily dampened by another major component of the tax overhaul: repeal of the individual mandate.
The repeal is likely to lower participation in the marketplace next year and could increase premiums by an average of 10%, according to a report by America's Health Insurance Plans.
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As both components of the tax law affect premiums, their individual impact is difficult to determine and likely varies by insurer.
Available 2019 premium increase requests for BCBS insurers have already shown wide deviation. Among Blue exchange insurers that saved last year under the tax law, Premera, which raked in over $200 million, proposed a 6% premium increase for 2019 compared to a 26.5% decrease in 2018.
BCBS Michigan requested a 4.2% premium increase for its ACA plans next year, compared to a 27% bump the year prior, according to state filings.