Posted on 09/12/2017 3:01:35 PM PDT by Altura Ct.
The Affordable Care Act exchange is collapsing in Virginia, with the last potential insurer pulling out of western Virginia and leaving about 70,000 people without the ability to purchase health insurance for 2018.
“Any individual, regardless of income, who purchased an individual policy — on the exchange or non-exchange — won’t be able to buy a policy next year,” Carilion Clinic Chief Financial Officer Don Halliwill said Tuesday. “When people think of the exchange, they think of poor people. That’s not accurate. It’s all income levels.”
About 40,000 of the people affected live within Carilion’s service area.
Should nothing change before the Centers for Medicare and Medicaid's Sept. 27 deadline for insurers to participate, parts of Virginia, including the Roanoke and New River valleys, will be the only places in the U.S. without at least one insurer, according to an analysis by the Kaiser Family Foundation. Open enrollment starts Nov. 1 for policies that take effect Jan. 1.
This year, three insurance companies offered individual policies in the Roanoke and New River valleys.
But this spring, Aetna announced that it would no longer participate in the marketplace. Last month, Anthem followed suit. And Optima Health said last week that it would no longer offer individual policies in areas of Virginia where its parent, Sentara Health, did not have hospitals and providers. Although Optima covered only a small percentage of people in western Virginia, the company had been expected to fill the void after Anthem announced its departure, meaning it would have been on track to sell 100 percent of the individual policies in the region.
Insurers blame President Donald Trump for making subsidies unreliable and Congress for failing to stabilize the market.
Virginia Secretary of Health Dr. Bill Hazel said Tuesday that Washington had manufactured this crisis, which will affect about 70,000 of the 350,000 Virginians who purchase policies on the exchange.
“They are the ones who have to fix it,” he said. “Our hands are all but tied.”
Hazel said he has been meeting with Virginia insurers, but none is willing to reenter the market as long as federal cost-sharing reduction payments are at risk. The payments are subsidies to lower-income people to help cover out-of-pocket expenses of high deductibles, co-payments and coinsurance.
Without the subsidies, insurers say healthier individuals would be unable to afford to use insurance coverage and so would opt to go without, leaving the insurers to cover only the sickest and costliest individuals.
Trump has called the subsidies an insurance bailout, has threatened to cut them off and let the ACA collapse, and has decided on a monthly basis whether to continue the payments.
“My members are large organizations that work with long-term planning. They make decisions based on years, not months,” said Doug Gray, executive director of the Virginia Association of Health Plans.
Trump and Congressional Republicans this year failed in two attempts to replace the Affordable Care Act and have also failed to stabilize the market, Gray said.
“We didn’t get into this by accident. It was by a conscious choice of leadership,” he said.
Though insurers across the nation are facing the same destabilizing forces, it appeared as of this week that the collapse of the marketplace is only affecting parts of Virginia.
The latest map by the Centers for Medicare and Medicaid shows at least one insurer for every county in the nation, but a map by the Kaiser Family Foundation reflecting last week’s deadline, when Optima pulled out, shows parts of Virginia as the only places lacking any coverage.
Katha Treanor, a spokeswoman for the Virginia State Corporation Commission Bureau of Insurance, said Optima on Tuesday asked to add a few localities back to its coverage area, but none is in western Virginia.
The bureau and Hazel have been working with some small out-of-state plans that have expressed interest in picking up parts of the uncovered jurisdiction. But deadlines are approaching.
The late date at which Anthem pulled out of the market has forced Virginia to scramble. Anthem provided the majority of the policies on the individual market, and it held about 70 percent of the policies in Carilion’s territory.
“Some other places were dealing with this earlier. Anthem waited until the second week in August to announce. If we had known in April, we could have been working to bring small plans in,” Hazel said.
Hazel said that if Congress stabilizes the cost-sharing reduction payments, Anthem or other insurers might reenter the market, though deadlines would need to be extended.
Gray isn’t as hopeful. Insurers who leave the market are locked out for five years, he said. Anthem is the only national insurer that didn’t pull out entirely, having retained a couple small localities.
If other insurers wanted back in, Congress would have to allow an exception, he said.
“President Trump said we need to let the system ‘implode’ and then created severe uncertainty around whether he would pay the cost-sharing payments, which has been a sticking point with insurers,” said Sen. Tim Kaine, D-Va.
Kaine and Sen. Mark Warner, D-Va., said committees they serve on are working on a fix.
“If the president isn’t willing to guarantee the payments and create certainty himself, we will do it for him,” Kaine said.
Rep. Morgan Griffith, R-Salem, blamed both the Affordable Care Act, and the Senate for failing to repeal and replace it, for the instability that prompted insurers to pull out of his district.
“In the face of Senate inability to act and to address the problem of insurers leaving the market, I am willing to work with my colleagues in Congress on both sides of the aisle to patch the collapsing system,” Griffith said. “To that end, I believe Congress must appropriate CSR [cost-sharing reduction] subsidies until such time as a true replacement for Obamacare can be implemented.”
Rep. Bob Goodlatte, R-Roanoke County, said several governors have stepped up to find ways to keep exchanges running in their states.
“I hope Gov. McAuliffe will consider a way to do this as well,” he said.
Goodlatte, whose district is widely affected by the insurers' pullout, said the problem was created by the Affordable Care Act.
“Unfortunately, the collapse of insurance exchanges shouldn’t be a surprise. From the very beginning, many have said, I included, that this law is simply unworkable and the systems put into place by it will not adequately serve American families. Now, those chickens have come home to roost,” Goodlatte said.
Meanwhile Carilion's Halliwill said people who have been buying individual policies might not understand that they won't be able to.
It's too soon to know the effect.
"Data would show that individuals who don't have insurance tend to delay care and not have routine services, which leads to more severe illnesses," he said.
Carilion, which provided $120 million in charity care last year, wants patients to know that they should still come in without insurance, he said. "We're the safety net for the uninsured and under-insured. We'll still be here," he said.
Excellent!
And the dominoes keep falling, pushing us closer to Single Payer Government-Run Full-Frontal Communist Healthcare!
I would personally like to thank (call out):
0bama.
Pelosi, you hag.
All Democrats.
President Trump needs to make the Dems CHOKE on this.
Virginia voted for it, they deserve it.
Reap what you sow.
gotta fix it! Right?
Go Obama! Go obamacare!
What a great ####ing idea that was.
I hope they are the 70K that voted for O & H. And all in the bluest of VA counties.
‘Insurers blame Trump for making subsidies unreliable’
‘Insurers’ only bought into Obamacare because they were getting bailouts from the taxpayers. Now the bailouts are drying up and the insurers aren’t keeping up their end of the devil’s bargain. Boo Hoo. Bring back CHOICE IN HEALTHCARE and let the market determine the coverage. I AM DONE WITH SOCIALISM.
Yes, you can blame them, but it never would have passed without republican help in a republican control house and senate. Here we sit with another republican house and senate and cannot repeal it.
and terry the terrible.
The ACA passed without a single GOP vote in either house.
What is “Republican” Senator Collins from ME and her traiterous GOP cohorts and all the Dems going to do now?
Let me guess.
Instead of voting for market based healthcare with competition, health savings accounts and being able to sell insurance across state lines, they’ll push single-payer, aka: socialized medicine. Just like they have in Cuba. Long waits, inferior treatment, dirty hosptial rooms etc.
When it was passed the Dems had a majority in the House and Senate. Not one Republican voted for it.
Thanks for nothing, you foul collection of worthless d-bags.
And now that Bitch McTurtle and Pall Ryno have a friendly President, they can't get their heads out of their butts and pass a repeal.
>> Insurers blame President Donald Trump for making subsidies unreliable and Congress for failing to stabilize the market.
The “insurers” can go to the Hell they created in partnership with Obama and the Democrat Thug Party.
Just send your medical bills to your repulsive governor McAuliffe, Virginians. The Democrats passed this flop so they are responsible for your woes.
Can you not buy an individual policy? I had one and never used their stupid exchange...
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