Despite the prospect of millions of new customers and measures to cushion insurers with disproportionately high claims in the early years, carriers worry that the sick will be first to sign up while the healthy stay away. Fears grew after claims came in far higher than expected for temporary “high risk pools” that had been established to cover the chronically ill until the full law took effect in 2014. The shortfall prompted the plans to close enrollment early.
“Insurance companies, very suddenly in my estimation, are getting very conservative and hesitant about being in the exchanges,” said Robert Laszewski, a Virginia-based consultant and former insurance executive. “All along, everybody, including the companies, assumed they would be in a lot of exchanges.”
UnitedHealth Group’s recent disclosure that it would offer plans in only a dozen state exchanges marked new disappointment for those hoping the exchanges will generate vigorous competition. Previously, UnitedHealth had said it would sell on as many as 25 exchanges.
Aetna plans to offer individual exchange policies in 14 states and may reduce that if some states look unprofitable or unprepared, chief executive Mark Bertolini said on a conference call in late April.
Cigna will focus on making exchange plans work well in five states rather than spreading efforts more thinly, said Ray Smithberger, who is in charge of the company’s individual business.
“What you see in the general market is just a hesitancy” over whether states will be technologically ready, he said in an interview.
The Blues characterize their approach very differently. “We’ve been in this market for more than 80 years, and we’ve been providing coverage in every Zip code to everybody. We imagine we will continue to do that,” said Alissa Fox, a senior vice president at the Blue Cross and Blue Shield Association.
— Kaiser Health News
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.