Projections: ACA plans will fall to one insurer in region

According to recent projections from the Centers for Medicare and Medicaid Services, Frederick, Warren and Shenandoah counties and the city of Winchester are all slated to have just one insurer through the 2018 Affordable Care Act marketplace.

The Aug. 16 and Aug. 23 projections mark a significant change from last year, where all three counties and the city had at least two insurers through the marketplace, according to a 2016 report by the nonpartisan health policy nonprofit Kaiser Family Foundation. (The Kaiser Family Foundation is not affiliated with the insurer Kaiser Permanente.)

The recent projections put the counties and city in an increasingly common position. According to the projections, more than 47 percent of all counties are projected to have just one insurer through the marketplace, leaving 29 percent of expected enrollees without a choice of insurer.

The number of counties with only one insurer has increased substantially in the past three years. According to the Kaiser Family Foundation report, 21 percent of Affordable Care Act enrollees last year had one insurer to choose from for 2017. The year before that, only 2 percent of enrollees were left without a choice.

Rick Mayes, professor of political science and co-coordinator of the Healthcare Studies Program at the University of Richmond, said that the large number of counties with one insurer will mean an increase in premiums for Affordable Care Act exchange plans. But for the majority of people on the exchanges who receive federal subsidies for their insurance, the changes will not dramatically alter how much money they will have to spend on the plans.

“It’s the federal government that has to increase the subsidies,” Mayes said. “Now, that’s a good thing for the customers; it’s not a good thing for the country.”

Mayes attributed the decreased competition to difficulties the Affordable Care Act has had in getting young and healthy people to enroll in the exchanges. One reason for this difficulty, he said, is the provision of the Affordable Care Act that allows people between 18 and 26 years old to stay on their parents’ plan.

“Way back when they passed the act in the first place, they didn’t anticipate as many 18-26-year-olds would stay on their parents’ plan” as wound up happening, Mayes said.

That has made it harder for insurance companies to make profits through the exchanges, he said.

Mayes said that the “ultimate solution” to this difficulty in finding young, healthy enrollees may be for the federal government to increase the amount of subsidies it pays insurers. That could make the exchanges more popular, stabilizing the market, he said.

But, Mayes said, “That’s not really lowering health insurance costs. …That’s not really a long-term solution.”

The recent projections follow Anthem’s Aug. 10 announcement that it would be dropping out of Virginia’s 2018 Affordable Care Act exchanges. In May, Aetna announced it would drop out of the exchanges.

Doug Gray, executive director for the health insurance business group Virginia Association of Health Plans, said that the remaining insurer for the region is likely Optima.

A spokesperson for the Centers for Medicare and Medicaid Services declined to say the name of the remaining insurer or insurers in the region. The spokesperson noted that finalized agreements between insurers and the states do not have to come in until Sept. 27.

Gray also said that the number of insurers could wind up being different than the current projections suggest.

“We don’t know that you’ll even have one carrier yet,” Gray said. “We’ll have to see what happens.”