Insurers are losing money on ACA plans
Despite millions of federal payouts under the Affordable Care Act's risk programs, some insurers say they're still in the red for their ACA plans, mostly because newer members are sicker and more expensive to cover.
Take Blue Cross Blue Shield of North Carolina. The insurer is receiving more than $343 million in reinsurance and other risk-related payments, but it lost $123 million on its ACA business, Patrick Getzen, BCBSNC's vice president and chief actuary, wrote in a blog post for the insurer.
In fact, BCBSNC closed 2014 with a net loss of $50.6 million--the insurer's first financial loss since 1999, FierceHealthPayer previously reported.
That's because "ACA customers are sicker and use more healthcare than individual customers historically have--and more than anyone projected," Getzen wrote. "We're seeing costs go even higher as more people with more health problems seek more medical care."
Getzen added that the reinsurance payouts to insurers only go "part of the way" toward covering the extra costs of their new members under the ACA.
That's one of the reasons BCNSNC requested such a large rate increase for next year--a 25.7 percent average premium for individual plans, reported the Charlotte News Observer.
And BCBSNC isn't alone. "Many insurers across the country are seeing similar trends in their ACA business," Getzen said.
Insurers have proposed drastic rate hikes for 2016. And many of those premium increases are a result of insurers reporting higher-than-expected volume of claims in 2014 and because they don't know how they will be compensated by the ACA's risk programs.
To learn more:
- read the BCBSNC blog post
- see the Charlotte News Observer article
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