Access Health CEO worried remaining insurers will quit exchange

Access Health CT CEO James Wadleigh

Washington – Access Health CT CEO James Wadleigh says he’s concerned that next year Anthem and ConnectiCare may quit Connecticut’s Affordable Care Act marketplace, where more than 100,000 Connecticut residents currently get their health coverage.

“Over the last five years Connecticut has been seen as a leader in the rollout of the Affordable Care Act, and I’m worried that we could be seen as the first marketplace not to have carriers in 2018,” Wadleigh said at an Access Health board meeting Thursday.

Wadleigh blamed the possible collapse of Access Health on Washington, D.C., and the uncertainty in the nation’s capital about the future of the Affordable Care Act —  especially a provision that subsidizes co-pays and deductibles for low- and medium-income people that would bring insurers about $7 billion this year and about $8 billion next year.

“I anxiously await to see what happens in the next few weeks,” he said.

Wadleigh said he’s been meeting with Anthem and ConnectiCare for a month, but his concerns the last two insurers remaining in Access Health may leave it stem from media reports that Anthem is seriously considering leaving all of the ACA exchanges next year and other insurers are abandoning those marketplaces, too.

The reason many insurers have given for their retreat from the ACA is that the customers in the exchanges are older and sicker than expected and they are losing money on the business.

Uncertainty over the future of the ACA is also playing a role – President Donald Trump and House Republicans plan to revive a bill that failed last month to repeal and replace Obamacare.

“The plan gets better and better and better and it’s gotten really, really good and a lot of people are liking it a lot,” Trump said at a joint news conference with the Italian prime minister on Thursday.

Wadleigh said the biggest immediate concern for insurers is whether the GOP-led Congress will continue a program Republicans hate and have gone to court to try to abolish – the cost-sharing program that subsidizes the co-payments and deductibles for low- and medium-income people.

The House GOP has sued to stop the program, arguing the payments are illegal because Congress never authorized them, and won its case in a lower court. The Obama administration appealed, and the Trump administration said it would continue the payments pending resolution of that appeal.

But insurers are concerned House Republicans will cut the money out of the federal budget.

“The cost-sharing subsidies are front and center as the biggest items they are worried about and are influencing their ability to determine rates,” Wadleigh said.

He also said there’s little time to solve the problem because insurers must submit their rates for next year to the Connecticut Insurance Department by May 1.

Wadleigh said elimination of the cost-sharing subsidies could add an increase of 10 to 20 percent to the rates insurers propose for next year.

He also said insurers are concerned the Trump administration is not enforcing the  ACA’s “individual mandate,” the requirement that almost everyone be covered by health insurance.

Access Health once offered consumers a choice of four insurers and a healthy number of plans.

UnitedHealthcare and the state’s health insurance co-op, HealthyCT, left the exchange last year.

In a conference call with investors earlier this month Anthem CEO Joseph Swedish said “we will make the right decisions to protect the business.”

“If we can’t see stability going into 2018, with respect to either pricing, product or the overall rules of engagement, then we will begin making some very conscious decisions with respect to extracting ourselves,” Swedish said.

ConnectiCare threatened to leave the exchange last year after the Connecticut Department of Insurance rejected its request for a 27.1 rate hike and approved only a 17.4 percent increase.

Despite the insurers’ hesitancy about staying in Access Health, Wadleigh said he expects them to submit rate quotes by the May 1 deadline, but they have until July to decide whether they actually will stay in the exchange.

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