Grow­ing in­sta­bil­ity in the Af­ford­able Care Act’s in­sur­ance ex­changes was the big­gest sto­ry­line in health in­sur­ance for 2016.

Modern Healthcare - - NEWS - —Bob Her­man

It started in April when Unit­edHealth Group CEO Stephen Hem­s­ley said his com­pany would only sell in­di­vid­ual-mar­ket ex­change plans in a hand­ful of states in 2017 due to more than $1 bil­lion in losses in 2015 and 2016. Aetna and Hu­mana soon fol­lowed with sim­i­lar re­treats.

There was a sub­plot that got less at­ten­tion. Not-for-prof­its like Kaiser Per­ma­nente and some Blue Cross and Blue Shield plans, such as Florida Blue, re­ported mak­ing money or break­ing even on ex­change prod­ucts.

Still, most in­sur­ers said they weren’t get­ting enough younger, health­ier peo­ple to bal­ance out the costs of older, sicker mem­bers. They also com­plained that some con­sumers gamed the sys­tem by sign­ing up to get care and then drop­ping cov­er­age. In ad­di­tion, peo­ple with in­comes too high to qual­ify for ACA sub­si­dies strug­gled to af­ford ris­ing pre­mi­ums and out-of-pocket costs.

The Obama ad­min­is­tra­tion’s an­nounce­ment in Oc­to­ber that in­di­vid­ual-mar­ket pre­mi­ums would rise by an aver­age of 22% across the coun­try cre­ated po­lit­i­cal tur­bu­lence for Democrats head­ing into the Novem­ber elec­tions.

Ris­ing out-of-pocket costs were an is­sue in em­ployer-based plans as well. Kaiser Fam­ily Foun­da­tion data showed that pre­mium growth slowed some­what in 2016 be­cause more em­ploy­ers shifted work­ers into high-de­ductible plans. Drew Altman, the foun­da­tion’s CEO, called the cost shift to con­sumers “the big­gest change in health­care in Amer­ica that we are not re­ally de­bat­ing.”

The en­tire in­dus­try, mean­while, watched closely as the An­them/Cigna Corp. and Aetna/Hu­mana merger plans pro­ceeded. The U.S. Jus­tice Depart­ment sued to block both deals, and the tri­als got un­der­way in the fi­nal weeks of the year.

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