Insurers may not be doing as poorly as advertised on Affordable Care Act exchanges

screenshot of Healthcare.gov websit
Health insurers have complained of financial losses from selling policies on Healthcare.gov and state-based exchanges.

Health insurers’ criticism of the Affordable Care Act exchanges may obscure the fact that those same critics’ individual market business shows signs of turning a corner after the first few volatile years of the healthcare reform law.

Blue Cross Blue Shield of North Carolina, which raised rates by about 32% this year, made nearly $400 million in the first three quarters of 2016 for individual on- and off-exchange plans, USA Today reports. That’s an abrupt change from when the insurer lost about $400 million on plans it sold on Healthcare.gov in 2014 and 2015, which CEO Brad Wilson blamed on an influx of sick, expensive-to-treat enrollees.

He also warned that BCBSNC might have to exit the marketplace, but ultimately the insurer chose to continue selling exchange plans in 2017. As for this year’s promising margins, company spokeswoman Darcie Dearth told the publication it’s too soon to comment on ACA plan profitability, noting the fourth quarter is often marked by higher medical utilization.

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Aetna, meanwhile, made more than $8 million on individual ACA plans in Pennsylvania and nearly $12 million in Texas, but will still exit the exchanges in both states next year, according to the article. In August, the insurer said it has lost $430 million on individual marketplace plans since 2014, and thus in 2017 will remain in just 242 of the 778 counties it served with exchange plans this year.

Aetna increased the number of plan offerings, though, in the four remaining states where it will sell ACA exchange plans next year, the article adds. Another another insurer, Molina, has been successful on the exchanges by designing plans similar to its Medicaid managed care products. 

To the Robert Wood Johnson Foundation’s Kathy Hempstead, such developments offer a slice of optimism about the exchanges. "It could be that at least some of these plans are turning a corner, and some may have hit bottom in 2015 in terms of financial performance," she told USA Today.

And Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt tweeted that the article confirmed what his agency has said all along:

 

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