Big ‘ if ’ snags insurers’ lifeline

Insurance coverage is likely to be restored on the federal health exchange for Ohioans in at least 19 of 20 counties where insurers recently announced they are pulling out.

But the measure appears to be only a temporary fix — and it may never happen if President Donald Trump carries out a threat to undermine Obamacare.

The Ohio Department of Insurance has found five insurers who are willing to expand into all but one of the underserved Ohio counties, Chris Brock, the department’s assistant director of public

affairs, said Monday. The search for a Paulding County insurer continues.

He cautioned, however, that nothing is guaranteed until the companies sign contracts with the federal government at the end of September. Even then, coverage would be certain only through 2018.

“This is not a commitment that they will be here in the next two years or five years or 10 years,” Brock said.

Indeed, uncertainty surrounding the future of health care continues to reign in Washington. Republican efforts to repeal or dramatically scale back the program have repeatedly failed on Capitol Hill, leaving Trump threatening to let Obamacare “fail.”

Many have interpreted those threats to mean the administration would end $7 billionin annual federal reimbursements to insurers for subsidizing prescription and medical copays for

lower-income Americans. Ending the subsidies would prompt double-digit premium increases and possibly send the federal and state health exchanges into a death sprial, experts have said.

Brock said the uncertainty in Washington could undermine arrangements in Ohio.

“Nothing is really final until these contracts are signed at the end of September,” he said. “There are things at the federal level that could change this.”

In a statement, Ohio Sen. Jay Hottinger, R-Newark, seemed to agree.

“The challenges and uncertainty in the marketplace continue to be a house of cards, and the slightest changes could result in further turmoil, but today we celebrate the good news of the five carriers who have stepped up to serve Ohioans in those counties,” he said.

Created under the Affordable Care Act, also known as Obamacare, the health exchanges were created so that individuals who are not otherwise covered could buy

health insurance. Those earning up to four times the federal poverty standard can qualify for federal subsidies for their insurance on the federal and state exchanges. (Ohio uses the federal exchange.)

Citing uncertainty about Obamacare’s future, megainsurer Anthem announced it would pull out of Ohio at the end of this year, leaving 20 counties without a coverage option. Dayton-based Premier Health Plan also announced that it would leave the nine counties in which it offered coverage on the health exchange at the start of 2018.

With about 11,000 Ohioans standing to lose coverage because of the moves, Monday’s news of a possible reprieve was welcomed by advocates.

“This is a great way to make sure people in those counties have access to some insurance,” said Steve Wagner, executive director of the Universal Health Care Action Network Ohio.

Tentative arrangements have been made to provide insurance options for 2018

in Coshocton, Crawford, Guernsey, Hancock, Harrison, Hocking, Holmes, Jackson, Knox, Lawrence, Logan, Morgan, Muskingum, Noble, Perry, Van Wert, Vinton, Williams and Wyandot counties, Ohio Insurance Commissioner Jillian Froment said in a statement.

Those counties have relatively small populations, making them less attractive to insurers, said Cynthia Cox, associate director for the Study of Health Reform and Private Insurance at the Henry J. Kaiser Family Foundation.

Typically, just 5 percent of a county’s population participates in the individual markets, meaning that insurers have to create networks of doctors and hospitals for a relatively small number of patients in rural counties, Cox said.

“It’s not a surprise that you would have only a handful of companies compete for that business,” Cox said.

She added that it’s also not surprising that four of the five insurers expanding into

the underserved Ohio counties — Buckeye Health Plan, CareSource, Molina Health Care of Ohio and Paramount Health Care — also operate Medicaid managed-care plans in the state. That means they already have provider networks in those areas, Cox said.

Medical Mutual of Ohio is the sole non-Medicaid insurer eying expansion into the underserved Ohio counties.

It’s unclear how much arm-twisting was needed to get the Medicaid contractors to expand onto the rural exchanges, but Cox said some states require all such contractors to also offer plans on the individual exchanges in all counties.

“That’s one of the only ways the states or the federal government can get insurers to go into some of these more rural counties,” she said.