Con­sumers face least choice in his­tory of health law

Daily Local News (West Chester, PA) - - BUSINESS - By Meghan Hoyer and Ri­cardo Alonso-Zal­divar

WASH­ING­TON » Amer­i­cans in the health in­sur­ance mar­kets cre­ated by Pres­i­dent Barack Obama’s law will have less choice next year than any time since the pro­gram started, a new county-level anal­y­sis for The As­so­ci­ated Press has found.

The anal­y­sis by AP and con­sult­ing firm Avalere Health found that about one-third of U.S. coun­ties will have only one health mar­ket­place in­surer next year. That’s more than 1,000 coun­ties in 26 states — roughly dou­ble the num­ber of coun­ties in 2014, the first year of cov­er­age through the pro­gram.

With in­sur­ance no­tices for 2017 in the mail, fam­i­lies are al­ready fac­ing dif­fi­cult choices, even weigh­ing whether to stay cov­ered.

“At this point we are at a loss,” said Ryan Robin­son of Phoenix. “We don’t know what the next step is.” He and his wife, Ni­cole, only have plans from one in­surer avail­able next year, and the com­pany doesn’t ap­pear to cover an ex­pen­sive im­mune-sys­tem med­i­ca­tion for their 11-year-old daugh­ter.

Phoenix is the mar­ket hardest hit by in­surer ex­its, shrink­ing from nine car­ri­ers to one. With many other com­mu­ni­ties af­fected, how­ever, the prob­lem of dwin­dling choice may cre­ate even big­ger po­lit­i­cal headaches than the ris­ing pre­mi­ums an­nounced ear­lier this week.

Largely as a re­sult of the Af­ford­able Care Act, the na­tion’s un-

in­sured rate has dropped to a his­tor­i­cally low level, less than 9 per­cent. But the pro­gram hasn’t yet found sta­ble foot­ing, and it re­mains po­lit­i­cally di­vi­sive. In­surer par­tic­i­pa­tion rose in 2015 and 2016, only to plunge.

Dwin­dling choice could be a trick­ier is­sue than ris­ing pre­mi­ums for the Obama ad­min­is­tra­tion and ad­vo­cates of the 2010 law, in­clud­ing Demo­cratic pres­i­den­tial can­di­date Hil­lary Clin­ton.

Most cus­tomers get fi­nan­cial as­sis­tance, and their sub­si­dies are de­signed to rise along with pre­mi­ums, which are in­creas­ing an av­er­age of 25 per­cent in states served by Health­ But there is no com­pa­ra­ble safety valve for dis­rup­tions caused by in­sur­ers bail­ing out.

“Ris­ing pre­mi­ums get all of the po­lit­i­cal at­ten­tion, but lack of choice be­tween in­sur­ers could be a big­ger prob­lem for con­sumers,” said Caro­line Pearson, a se­nior vice pres­i­dent with Avalere.

Five states — Alaska, Alabama, Ok­la­homa, South Carolina and Wyoming — have one par­tic­i­pat­ing in­surer across their en­tire ju­ris­dic­tions. Only Wyoming had faced that predica­ment this year.

An­other eight states — Ari­zona, Florida, Ge­or­gia, Mis­souri, Mis­sis­sippi, North Carolina, Ne­vada and Ten­nessee— have only one par­tic­i­pat­ing in­surer in a ma­jor­ity of coun­ties.

Cit­ing big fi­nan­cial losses, sev­eral mar­quee in­sur­ers sharply scaled back their par­tic­i­pa­tion for next year. United Health­care ex­ited from more than 1,800 coun­ties, and main­tains only a mi­nus­cule pres­ence, ac­cord­ing to the anal­y­sis. Hu­mana nearly halved the num­ber of coun­ties where it of­fers plans.

In­sur­ers say en­roll­ment was dis­ap­point­ing, pa­tients were sicker than ex­pected, and an in­ter­nal sys­tem to help sta­bi­lize pre­mi­ums didn’t work well. The Obama ad­min­is­tra­tion says in­sur­ers are cor­rect­ing for ini­tially pric­ing their plans too low.

Health­ has taken steps to help con­sumers whose in­surer is leav­ing by match­ing them to the clos­est com­pa­ra­ble plan on the mar­ket­place next year.

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