ACA options dwindle in state

Insurers fleeing ‘Obamacare’ marketplace

For many who buy their own health insurance, next year is shaping up to be a challenging and financially painful year.

Six major health insurers that sell plans directly to consumers are bowing out or scaling back on the Affordable Care Act marketplace in Arizona.

Only two marketplace insurers will remain in Arizona’s largest county, Maricopa County, and the exodus has left Pinal County without a single insurer willing to offer a marketplace option next year to the nearly 10,000 people now enrolled.

Federal and state officials caution that things could change between now and Nov. 1, the scheduled start of the three-month enrollment period. They cite regulatory efforts to woo at least one Pinal County insurance provider.

Arizona Department of Insurance officials do not expect to finalize the list of insurers until midto late September, said department spokesman Stephen Briggs. The state agency, which regulates the insurance market in Arizona, can’t say for certain at this point which plans will be available during enrollment.

But six insurance companies already have announced plans or disclosed in state filings their intention to drop out or scale back marketplace coverage in 2017. Aetna, Health Choice Insurance Co., Humana and United-Health Group will discontinue marketplace plans in Arizona. Health Net will offer plans only in Pima County next year, according to state Department of Insurance filings.

Blue Cross Blue Shield, Arizona’s health insurance mainstay, announced in June that steep financial losses had prompted it to stop

selling marketplace plans in Maricopa and Pinal counties starting next year. The company had offered plans in every county since the Affordable Care Act marketplace launched in 2014.

However, Blue Cross Blue Shield has since said it is reconsidering in the wake of Aetna’s exit.

The trickle of insurers exiting — and rate-hike requests of as much as 122 percent for remaining insurers — is making consumers nervous. Some are taking steps to prepare for what they fear could be delayed care and long trips to doctors’ offices and hospitals.

Claburn Niven Jones, who owns a home in Scottsdale and a condo in the San Francisco Bay Area, said the insurance shakeout has prompted him to take steps to relocate to California. The reason? The 63-year-old cancer patient doesn’t think that there will be enough insurance and health-provider options for Maricopa County residents next year.

Diagnosed with prostate and thyroid cancers, Jones envisions long waits for specialists with crowded appointment calendars.

He doesn’t want to take that chance.

Enrollment figures show that more than 126,000 Maricopa County residents selected marketplace health plans offered by eight insurance companies as of Feb. 1. Those marketplace customers who seek to continue coverage will have only two options left by Jan. 1, 2017 — Phoenix Health Plan and Cigna.

“If you add them all up and throw them into a network, you’ll never see a doctor,” said Jones, a retired certified public accountant. “It’s going to be a health-care disaster for the people of Phoenix.”

Neither Phoenix Health Plan nor Cigna is willing to discuss proposed provider networks until state and federal insurance regulators sign off on their plans for next year.

Briggs said the state Department of Insurance uses formulas to make sure there are enough doctors, labs and hospitals to handle the projected number of customers.

He acknowledged that the remaining insurers could face heavier customer loads after so many other insurers have dropped out or scaled back.

“They do have to demonstrate their ability — or lack thereof — to handle the (customers) in their network,” Briggs said.

Jones has an insurance plan through a unit of UnitedHealth Group that will expire Dec. 31. UnitedHealth won’t offer an individual plan next year in Maricopa County.

Jones said he began investigating other marketplace options even though he does not qualify for subsidized ACA coverage.

He believes both Cigna and Phoenix Health Plan will be inundated with marketplace customers, and he said he can’t wait until Nov. 1 to find detailed information on the insurers’ networks of doctors and hospitals.

He will undergo proton radiation treatment this fall for his prostate cancer. He also needs regular appointments with an endocrinologist to monitor his thyroid cancer, which requires periodic scans following an earlier surgery.

Jones said he is preparing to establish full-time residency in California, where he owns a condominium in San Mateo.

“We moved to Arizona for a quality of life and (lower) expense,” Jones said. “I can’t get insurance, so I will have to leave.”

Other Arizonans, too, are worried that Maricopa County’s narrowing options could pose challenges.

North Scottsdale resident Jane Vesely, 62, has a Blue Cross Blue Shield plan that will expire at the end of this year. She wants a marketplace plan, but she worries that neither Cigna nor Phoenix Health Plan will provide an in-network hospital near her house.

Cigna’s current marketplace plans this year use its Connect network, which includes Banner Health hospitals and some specialty hospitals. The network does not include HonorHealth’s Scottsdale hospitals closest to Vesely’s home.

The other marketplace plan, Phoenix Health Plan, is owned by the forprofit hospital chain Tenet Healthcare. It also does not contract with Scottsdale-based HonorHealth.

It’s unclear if the Department of Insurance will ask the two plans to expand their existing networks.

Vesely long had access to hospitals, doctors and specialists near her home through her husband’s employer-provided health plan. Her husband retired in 2014 and is on Medicare. She has to wait more than two years before she’s eligible for the federal health program for those 65 and older.

“The exchange was healthy (in 2014), and we made the decision that I don’t really have to go back to work,” Vesely said.

Now, she may need to get a job that offers health insurance due to the fraying marketplace.

“I have a feeling there are a lot of people like me who may be in a similar position,” she said.

The U.S. Department of Health and Human Services released a report Wednesday highlighting the affordability of marketplace plans for most people. Even if insurers raised rates by an average of 50 percent, 72 percent of Arizonans could buy health coverage next year for $100 or less each month after tax-credit subsidies are accounted for, the report said.

Tax credits are an Affordable Care Act tool used to offset the cost of monthly premiums for individuals who earn between 138 percent and 400 percent of the federal poverty level. More than 124,000 Arizonans who were enrolled in a plan as of March 31 had received a tax credit. But another 55,000-plus residents paid the full amount for marketplace plans, and they could face significant rate hikes next year.

Phoenix Health Plan will seek to raise rates on marketplace plans by an average of 122 percent, while Cigna has requested a 19 percent increase. Blue Cross Blue Shield, expected to be the only marketplace option in most rural Arizona counties, is seeking an average rate increase of 51 percent.

The Department of Insurance is reviewing the proposed rate increases. However, it does not have the authority under state law to reject a rate increase. The state’s review can only determine whether an insurer’s rate change is reasonable or unreasonable.

In the past, insurers have agreed to modify rate requests that state regulators determined were unreasonable. There’s no guarantee that insurers will do that this year, particularly with a majority of Arizona counties expected to have only one marketplace insurer.

“Even if we go back to a provider to say, ‘You haven’t demonstrated or justified the increase,’ they can say, ‘Well, we appreciate that. This is what we think we have to charge in order to not go bankrupt,’ ” Briggs said.

While the Department of Health and Human Services report emphasized the affordability of plans for those who qualify for health subsidies, it did not address the narrowing of health-care options in Arizona and other states.

Ben Wakana, the Department of Health and Human Services’ deputy assistant secretary for public affairs, said it’s important to look at how the federal health law has transformed the insurance market.

“Four years ago, companies in the individual market relied on a business model of largely denying coverage to people with pre-existing conditions,” Wakana said.

He noted that the federal health-care law now forbids marketplace insurers from denying coverage to the sick, and most people can buy coverage at subsidized rates.

“It has helped to get this country to the lowest uninsured rate on record,” he said.

"It’s going to be a health-care disaster for the people of Phoenix." CLABURN NIVEN JONES RETIRED CERTIFIED PUBLIC ACCOUNTANT AND CANCER PATIENT