The California state exchange, Covered California, is pumping millions of additional dollars into its marketing budget to promote ACA enrollment, and it’s giving the federal government an extra month to commit to paying next year’s cost-sharing reduction subsidies before it allows insurers to hike 2018 rates.
To keep insurers from exiting the exchanges, Covered California also said it will allow those plans that incur unexpected losses due to federal policies and uncertainty, such as that around the enforcement of the individual mandate, to recoup those losses over the next three years. The ACA gives state regulators the power to limit insurers’ profits.
The steps taken by Covered California are just one example of how state-based exchanges could mitigate the problems caused by the uncertain policy environment. Several other states, including Delaware, have announced that next year they will not participate in the exchanges. The insurers blame financial losses and mounting uncertainty over federal funding and rules that govern the exchanges.
Blue Cross and Blue Shield of Kansas City says it plans to withdraw from Obamacare next year, citing big losses and uncertainty. The move would leave nearly 19,000 residents in Western Missouri without a coverage option unless another carrier steps in. It said that it’s lost more than $100 million on ACA plans in the three years since the exchanges opened.
Anthem said it won’t participate in Ohio’s ACA exchange next year, citing growing uncertainty over the law’s future. The move will leave about 10,500 Ohio residents in at least 18 counties without an insurance option on the exchange unless another carrier steps in.
As one can see the ACA is in turmoil, but even where the ACA exchanges are functioning, healthcare providers must deal with huge out-of-pocket ACA deductibles, which are straining revenue cycles across the country. Patient financial responsibility has grown from 23.3 percent to 26.9 percent for outpatients and 10.2 percent to 12.1 percent for inpatients.
In 2017, the out-of-pocket maximum for ACA can range from $7,150 for an individual plan to $14,300 for a family plan before marketplace subsidies kick in. Healthcare providers are struggling with collection rates as they try to adapt to increasing patient responsibility amounts for insured self-pay co-pays and deductibles.
Compounded with the “shaky” status of the ACA, this high deductible trend is expected to grow over the next few years. As a result, both patient liability and bad debt are on the rise and healthcare providers are experiencing unprecedented revenue and margin pressure. Hospitals and clinics have become like retail organizations, which need to provide their consumers with access to payment capabilities at point of service, via the web, through payment plans, and more.
Payers need to continue to monitor their risk score, health of their members and utilization in order to succeed in the ACA market place.
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