Shenandoah, Frederick, Winchester down to zero ACA insurers

Shenandoah and Frederick counties and the City of Winchester are no longer slated to have any insurers in the Affordable Care Act marketplace, following a decision by Optima Health to abandon its coverage in much of the state.

Optima said in a statement Wednesday that it would only serve areas that have Sentara hospitals and physicians. (Optima is the business name of Sentara Health Plans, the insurance division of Sentara Healthcare.)

“The decisions we made were challenging ones given the recent changes and ambiguities in the marketplace,” Michael Dudley, president and CEO of Optima was quoted in the statement as saying. “Our most recent filing with the state reflects these dynamic changes, as would be expected in these circumstances.”

Optima was expected to be the sole Affordable Care Act insurer in the two counties and Winchester after Anthem announced it would leave almost all parts of Virginia in August.

But Doug Gray, executive director of the Virginia business group Virginia Association of Health Plans, said that expectation was unreasonable.

“When Anthem dropped out, [Optima] went back to the drawing board and looked at what they could do,” Gray said.

Gray said that Anthem’s decision left Optima with a sick and expensive pool of enrollees.

The Northern Virginia Daily was unable to reach Optima for comment. But in its statement, Optima cited Anthem’s decision, and a high level of uncertainty about what, if anything, Congress will do to shore up the Affordable Care Act after  attempts to repeal and replace it collapsed earlier this year.

Following Optima’s decision to not participate in the Affordable Care Act marketplace in the two counties and Winchester, several counties in Virginia will have no projected insurers taking part in the exchanges. That will leave the country with so-called “bare counties” for the first time since Aug. 24, when CareSource agreed to cover Paulding County in Ohio.

Ken Schrad, spokesperson for the State Corporation Commission, said that the state’s Bureau of Insurance will try to fill up the empty counties.

“It is in discussion with carriers to see if the counties and/or cities that are currently bare will at least have one choice,” Schrad said. “So it’s a work in progress.”

But while insurance regulators were successful in filling bare counties in August, Deputy Secretary of Health and Human Resources Joe Flores said that it is unlikely that Virginia will replicate past success.

“We can’t ensure that these counties will have an insurer,” Flores said. “In fact, it’s probably unlikely that we’ll be able to do that.”

Flores said that Virginia has only a limited ability to manage Affordable Care Act plans.

“We don’t have a lot of flexibility at the state level,” Flores said. “We sat down with the [insurers] yesterday and tried to listen to their concerns,” Flores said. “Their concerns reside mostly in Washington.”

Flores said that insurers are mostly worried about marketplace uncertainty and threats by President Trump to cut cost-saving reduction (CSR) subsidies, or payments the government makes to reduce the cost of insurance for subsidized enrollees. Without the federal government paying for the subsidies, the insurers will have to pay the CSRs.

“That’s the real sticking point to [insurers], is the cost-sharing reductions,” Flores said.

Optima’s announcement leaves only Warren County in this region with an insurer on the Affordable Care Act exchanges. Flores said that Warren County will be insured by Cigna.