Healthcare.gov may have only one insurance provider here next year

It looks like Blue Cross and Blue Shield of Oklahoma may be the only company to offer individual policies on the state’s federally run health insurance exchange next year.

The chief executive of UnitedHealth Group, the only other participating carrier for 2016, announced Tuesday that his company will exit most of the 34 exchanges in which it’s participating — including Oklahoma’s, which it entered only this year.

Mike Rhoads, deputy commissioner of the state Insurance Department, said about 5,000 Oklahomans currently are covered by UnitedHealth plans sold on healthcare.gov. About 95 percent of the 135,000 residents covered are insured through BCBSOK, he said.

Insurance companies must file by May 11 with the federal government to participate on next year’s exchange, Rhoads said.

Rhoads said UnitedHealth Group has been making overtures about leaving the exchange market for the past six to eight months. The Oklahoman announced the likelihood in November.

Meanwhile, the company continues to be a competitive player in the group insurance market, as well as the off-exchange individual market and the on-exchange tax-advantaged small group market for employers of two to 49, Rhoads said.

Since 2014, when exchanges were launched under the Affordable Care Act, the number of participating insurance companies on Oklahoma’s exchange has dwindled from four (BCBSOK, Aetna/Coventry, Global

Health and Community Care), to three in 2015, and then to two in 2016.

At least one independent health insurance agent isn’t happy about a potential Blue Cross and Blue Shield monopoly in 2017.

“It’s sad for the consumers. … We don’t see any good coming from this,” said Emily Hedinger of Benchmark Financial.

Blue Cross already has eliminated most of its better plans, leaving consumers with products with high premiums, high deductibles, high out-ofpocket maximums and smaller provider networks, Hedinger said.

“The system is being deluged with people who have health problems and are a burden on the carriers,” she said. “With BCBS being the only carrier in Oklahoma, they will be weighed down with even more costs and who’s to say they’ll be able to continue as a carrier,” she said.

UnitedHealth CEO Stephen Hemsley said Tuesday his company expects losses from its exchange business to total more than $1 billion for this year and last. He said the company can’t continue to broadly serve the market created by the ACA’s coverage expansion, due partly to the higher risk that comes with its customers.

UnitedHealth currently covers 795,000 people and so far has partially or fully exited five states: Arkansas, Georgia, Louisiana, Michigan and Oklahoma.

Rhoads said many consumers who are now guaranteed coverage under the ACA have taken out exchange plans, had bypass surgeries, kidney transplants and other expensive care, and then stopped paying their premiums.

BCBSOK, which gained approval to raise rates on exchange plans by 35 percent this year, told The Oklahoman last fall that the prices the company charged in 2014 and 2015 did not cover costs.

However, spokeswoman Ashley Hudgeons said Tuesday, “BCBSOK remains committed to providing access to affordable, quality health care for individuals throughout the state, and we intend to file products for participation in the individual marketplace in 2017. However, no final decisions have been made, and in order to ensure a stable marketplace now and in the long term, we need adequate and sustainable rates that will cover the cost of health care for our members, as well as market rules that encourage broad participation among consumers.”

Rhoads said it all comes down to setting rates correctly to carry the risk pool, and predicts another round of steep increases for 2017 exchange plans.

Some 80 percent of Oklahomans enrolled in the plans qualify for government subsidies.