Medica Health, Nebraska’s last remaining Obamacare compliant individual insurance provider, has not yet decided whether it will continue to offer plans next year, according to the Omaha World Herald.
Should Medica join the ranks of providers that have left the state’s Obamacare exchanges, some 100,000 Nebraskans will be left without an option for Obamacare insurance.
Individuals looking for policies not connected with an employer or government sponsored plan will be left with no options, leaving them exposed to fines imposed under the individual mandate clause of Obamacare.
“Things are still changing daily,” Geoff Bartsh, vice president for Medica’s individual and family business told the Omaha World Herald. “We’re still looking at changes and will continue to evaluate things. We are still planning to participate in the Nebraska market for 2018. We haven’t made any final decisions on that yet.”
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Losses from the two plans, called Bronze and Catastrophic, could reach $12 million this year and would continue next year even if premiums increase by 50 percent or more, Dale Mackel, Blue Cross executive vice president told the Omaha World Herald.
The Omaha-based company discontinued most of its Obamacare compliant individual plans for this year but left the Bronze and Catastrophic plans in place in an attempt to provide some access to individual coverage. The company hoped it would be able to at least break even on the plans but instead “we just continue to see the claims costs outpace premiums,” Mackel said.
“It’s just left us at a point where we feel like the best decision for our members, to remain stable and secure for all of our members, is to exit that portion of the business,” he said.
The company faced significant problems due to a lack of young, healthy people enrolling in their Obamacare plans, a problem familiar to many Obamacare providers throughout the country.
The risk pools on the Blue Cross’ remaining Obamacare plans were not diverse enough, as five percent of enrollees were responsible for 74 percent of the claims on the Bronze plan and 2 percent of the members were responsible for 59 percent of the claims on the Catastrophic plan.
Mackel explained that if Blue Cross left the two plans in place for next year premiums would increase by more than 50 percent on top of the 50 percent increase in place for this year.
Cynthia Cox, a deputy director of the Kaiser Family Foundation, a health care focused policy think tank, told the Omaha World Herald that its possible Medica could remain the only Obamacare compliant provider but they would face the same issues that plagued Nebraska’s Blue Cross affiliate.
“Medica doesn’t have the same kind of presence or history that the Blue Cross Blue Shield affiliates have,” Cox said. “It would be difficult,” for the company to remain on the state’s Obamacare exchanges.
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