With Health Law in Flux, Insurers Scramble to Meet Filing Deadline


“We’re confident that when the dust settles, the market for health insurance will stabilize in time for 2018,” Mario Schlosser, the company’s chief executive, wrote in a blog post. “For all of the political noise, there are simply too many lives at stake for representatives in Washington, D.C., not to do what’s right for the people.”

The company said that partnerships with health systems like the Cleveland Clinic to offer new plans in northeastern Ohio will allow it to be successful. “If you have the right products and the right partner, you can make it work,” Mr. Schlosser said.

Even as Senate Republicans hurry to finish their plan to overhaul the law, insurers must meet a series of state and federal filing deadlines. While the Wednesday deadline does not represent a final commitment by the insurer, “it will be a good indicator of the health of these markets,” said Sabrina Corlette, a research professor at Georgetown University.

If an insurer misses the Wednesday deadline, regulators could still choose to accept a last-minute application, as they did last year in Arizona, to make sure residents had access to a policy through the state marketplace. “State officials and governors are going to be very pragmatic to make sure people have coverage,” Ms. Corlette said.

Oscar’s announcement follows a flurry of decisions in recent days by insurers gambling on the existing market. Medica, a small nonprofit insurer, said Monday that it would offer plans statewide in Iowa, although it is seeking rate increases that average 43 percent. Its decision would cover the yawning gap left by Aetna and the state Blue Cross plan, which exited the market for next year and raised the possibility that no carrier would offer coverage to the bulk of the state’s residents.

Centene, another large insurer, announced its plans last week to offer coverage for the first time in Nevada, Missouri and Kansas.

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Joseph R. Swedish, Anthem’s chief executive, at a House hearing in 2015. He recently told CNBC, “We may have to exit certain markets because those markets are not sustainable.”

Credit
Jacquelyn Martin/Associated Press

But other insurers, even those who are submitting proposals, seem ambivalent about staying. Two of the major companies that offer Blue Cross plans say they may file to meet Wednesday’s deadline but have not made any final decisions.

Health Care Service Corporation, which operates nonprofit Blue Cross plans, said it would file proposals in all five states where it offers coverage, but could still decide to leave. The insurer covers more than one million people in the individual market.

Anthem, a major for-profit insurer offering Blue Cross plans in 14 states, has already decided to pull out of Ohio but would not disclose its projections elsewhere. “We may have to exit certain markets because those markets are not sustainable,” Anthem’s chief executive, Joseph R. Swedish, said in an interview with CNBC last week.

Anthem said it would not make its filings public, leaving it up to state regulators to decide whether to disclose its plans.

The exit by insurers like Aetna and Humana, as well as by some Blue Cross plans, is likely to lead to many more areas in the country that have only a single carrier in the state marketplace, according to a recent analysis by Avalere, a health care consulting firm.

But while the overall market is worsening, “there is a lot of variation by local market,” said Dan Mendelson, Avalere’s president. “There are some markets that are doing fine,” he said, while others, particularly rural ones, could still be left without an insurer willing to offer coverage.

Premiums are also likely to be higher, according to Avalere, which analyzed filings in eight states. Insurers are seeking an 18 percent increase, on average, for the most popular so-called silver plans.

Many insurers are blaming the current political uncertainty when asking state regulators for sharply higher prices. The Trump administration and Congress have yet to commit to critical funding for subsidies worth billions of dollars to low-income individuals. Insurers are also concerned that the administration will stop enforcing the penalties people face when they choose to go without coverage, which they say would also drive up prices.

Insurers “are going to build all of this uncertainty into their rates to the maximum extent to protect themselves,” Ms. Corlette said.

Even those insurers that plan to stay say the market has been challenging. While its losses have narrowed, Oscar lost about than $200 million last year and said that other changes were needed to stabilize the market. “We are not immune to the pressures in the individual market,” Mr. Schlosser said.

But he said he is working closely with state regulators to continue offering policies. “We are fighting the good fight in the trenches,” he said. “They know they need to make the market work.”

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