Hall County will likely lose half its current insurance providers within the Affordable Care Act marketplace next year, according to an analysis by the Kaiser Family Foundation. The move would affect about 10,400 residents who buy individual exchange coverage.
The exit of insurers, coupled with rising premiums, has re-energized the political firestorm over what is commonly referred to as “Obamacare,” the federal health care legislation passed in 2010 by Congress without Republican backing that created a network of market exchanges where those without health insurance could buy plans.
U.S. Sen. Johnny Isakson, R-Ga., said last week on the floor of the Senate that the ACA is but a broken promise, and that patients have a shrinking pool of doctors and health plans to choose from.
“Just last month, after Aetna, United Healthcare and Cigna announced they would leave Georgia’s marketplace, Blue Cross (Blue Shield) filed its third premium increase for the third time this summer, an increase of 21.4 percent,” Isakson said. “Earlier in the summer, Humana announced the average premium increase in the state of Georgia of a whopping 67.5 percent. And in 2016, all 159 counties in Georgia had at least two provider options. Next year, 96 counties in Georgia will only have one option.”
Most counties with just one option are rural, and government subsidies will lighten the burden of premium increases for some.
The analysis by Kaiser, a nonprofit, nonpartisan organization focused on national health issues, found that in almost a third of counties across the nation, marketplace enrollees may have access to just one plan next year, affecting about 19 percent of all enrollees.
Health insurers said they have to raise premiums as more sick people access coverage. The ACA prevents insurers from denying coverage to individuals with pre-existing conditions.
But supporters of the health law say states like Georgia, who have failed to expand Medicaid coverage with federal subsidies, are driving some of the problems seen today.
“Consumers who live in states that have expanded Medicaid are seeing lower-cost marketplace plans than consumers in states that have not expanded,” said Laura Colbert, director of outreach and partnerships for Georgians for a Healthy Future, an advocacy group that supports the ACA. “Georgia's decision not to close its coverage gap may have had a negative effect on marketplace enrollment, thus undercutting the success of insurance carriers in the state and influencing their decisions to participate in Georgia's marketplace.”
In Hall, 17.6 percent of residents remained uninsured in 2014, according to the latest census figures, or about 33,281 people. But that’s down from 20.7 percent, or 35,548 people, in 2013.
The county’s uninsured rate, however, is higher than averages for the state, at 15.8 percent, and nation, at 10.4 percent.
“The marketplace is experiencing changes that should be expected in such a young market,” Colbert said. “Some insurance carriers are seeing early successes in the marketplace and may expand into areas that other carriers have exited.”
According to Kaiser, Hall County will go from having six insurers in the marketplace in 2016 to just three in 2017.
Brett Fowler, vice president and partner at Turner, Wood & Smith Insurance in Gainesville, said he is aware of two carriers likely to continue offering plans within the marketplace next year: Blue Cross Blue Shield and Alliant.
“We are aware of two at this time, so I am not sure that we will get to three,” he said.
While insurers dropping out won’t impact businesses with group health insurance plans, Fowler said Hall residents who are self-employed “will have fewer options to choose from along with the narrow networks that can come from individual health insurance.”
The marketplace plans for 2017 will be available beginning Nov. 1.
Julie Saxton, director of managed care at the Northeast Georgia Health System, said patients need to check with their physicians to see if they will be included in the provider network to continue having access to in-network care at NGHS hospitals.
“We are working with our contracted payers to confirm their plans for participation in the marketplace in 2017,” she added. “From what we know today, several of these payers will not offer plans in the 2017 calendar year.”