Praeger says problems driving insurance companies from ACA marketplace are fixable

Former Kansas insurance commissioner says repeal of health reform law unrealistic option

by Jim McLean, KHI News Service

Former Kansas Insurance Commissioner Sandy Praeger says members of Congress should set aside partisan differences and fix problems with the Affordable Care Act.

Failing to do so, she warned, could hasten consideration of a single-payer system.

Praeger, a Republican who crossed party lines while in office to support the ACA, says the problems that are causing some insurance companies to pull out of the online health insurance marketplace are fixable.

“There are some things that could be done if we could get Congress to be willing to come to the table to try to solve problems,” Praeger said during a luncheon speech Wednesday at the Topeka YWCA. “That really hasn’t been the case now for a few years. But they could fix it.”

Three in Kansas marketplace

Some of the nation’s largest health insurance companies have withdrawn from the ACA marketplace, including UnitedHealthcare, Anthem and most recently Aetna. In addition, many of the companies staying in the marketplace are limiting their offerings to plans that are more restrictive than many offered on the open market.

In Kansas, only three companies are offering plans in the marketplace for 2017. Medica, a nonprofit company based in Minnesota, agreed to join when United withdrew. Blue Cross and Blue Shield of Kansas and Blue Cross and Blue Shield of Kansas City remain but have requested large premium increases.

Blue Cross and Blue Shield of Kansas, which operates in 103 of the state’s 105 counties, has requested a 47.4 percent rate increase. Blue Cross and Blue Shield of Kansas City, which operates in Johnson and Wyandotte counties, has requested an increase of 28.1 percent.

Current Kansas Insurance Commissioner Ken Selzer is expected to make rate-setting decisions next week.

Coventry Health and Life, an Aetna subsidiary, withdrew in August after initially indicating it would participate but sell only exclusive provider organization, or EPO, plans, which pay only for in-network care.

Four companies are expected to offer plans in Missouri: Blue Cross and Blue Shield of Kansas City, Cigna, Anthem Blue Cross Blue Shield (Healthy Alliance Life) and Humana. They are proposing rate increases ranging from Cigna’s 9 percent to Humana’s 34.9 percent.

Approximately 90,000 Kansans and 252,000 Missourians have marketplace plans, according to the U.S. Department of Health and Human Services.

Pressure for single-payer?

Insurance companies are withdrawing from the ACA marketplace because they’re losing money, Praeger said. In part, that is because a high percentage of the people purchasing marketplace plans are older and sicker than anticipated. She said too many younger, healthier people are choosing to pay tax penalties rather than buy insurance.

“The companies are saying, ‘Wait a minute. If only the older, sicker group is buying in and the younger, healthier group isn’t, we can’t do this anymore,’” Praeger said.

Congress could help solve that problem by increasing the penalties for not purchasing insurance and allowing companies to charge young consumers significantly less, she said.

Elected officials who ignore the problems and continue to advocate for repeal of the health reform law aren’t being realistic, Praeger said.

“The notion that somehow we would repeal this and go back to a system where people could be denied coverage based on their health conditions, or their age, or their sex, I just can’t imagine that could possibly happen,” she said.

What is more likely, she said, is that pressure will build for converting to a government-run single-payer system.

That is also the prediction of former U.S. Secretary of Labor Robert Reich, who served in President Bill Clinton’s Cabinet.

In a recent opinion piece published in several newspapers across the country, Reich said while “Obamacare can be patched” by increasing subsidies and forcing more healthy Americans to buy insurance, those would be “Band-Aids,” not long-term solutions.

He said the “real choice” is whether to continue propping up an unnecessarily expensive system run by insurance companies, in which sick people will find it increasingly difficult to get affordable coverage, or transitioning to a government-run single-payer system “dedicated to lower premiums and better care for everyone.”

“We’re going to have to choose eventually,” he wrote.

However, Republicans in Congress continue to call for repeal of the ACA as a part of their recently announced “Better Way” agenda.

Kansas 2nd District Congresswoman Lynn Jenkins said the GOP plan is a set of common-sense proposals to “get the government out of the way by implementing practical solutions to real problems.”

The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.

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