More insurers are expected to sell individual coverage under the Affordable Care Act known as ... [+]
Blue Cross and Blue Shield plans dominate the enrollment of individual Americans in health plans purchased on exchanges under the Affordable Care Act, but that could change given the pandemic and historic unemployment.
Nearly half, or 47%, of all marketplace enrollment also known as Obamacare in 2018 came via plans owned, operated or affiliated with Blue Cross Blue Shield companies, according to a new analysis by the Urban Institute.
But consumers and Blue Cross plans can expect more competition in the next two years as bigger carriers like UnitedHealth Group’s UnitedHealthcare health insurance unit look to re-enter some markets for 2021 and existing companies that sell individual coverage under the ACA like Centene are already planning on big increases in revenue and Obamacare enrollment for 2020.
“Blue Cross Blue Shield-affiliated insurers hold all or close to all of the enrollment in 11 states’ marketplaces,” the Urban Institute report said, citing Alaska, Alabama, Delaware, Illinois, Louisiana, North Carolina, North Dakota, New Hampshire, Oklahoma, South Carolina, Wyoming as markets dominated by the Blues brand.
Meanwhile, in nine other states (Arkansas, Florida, Hawaii, Kansas, Michigan, New Jersey, Pennsylvania, Tennessee, West Virginia), “Blue Cross Blue Shield plans have the majority of enrollment, though they face increasing competition from other insurer types, typically Medicaid insurers,” Urban Institute researchers.
To be sure, large well-capitalized health insurers like Centene, Molina Healthcare and UnitedHealth Group’s UnitedHealthcare are already planning to see their business administering Medicaid health benefits grow as Americans lose their employer-based coverage and become eligible for the ACA’s individual coverage or Medicaid benefits for poor Americans.
As one example, Centene in April said it expects the rise in unemployment amid the spread of the coronavirus strain COVID-19 to boost Medicaid and Obamacare enrollment in the coming months and increase revenue by $4 billion in 2020.
“The employer market is shrinking, and carriers will want to follow their members to the marketplace and Medicaid,” says Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, which funded the Urban Institute study.
“This suggests there will be more entry into an increasingly competitive marketplace,” Hempstead added. “Carriers may feel they will be most successful in markets where they are already participating in Medicaid, as suggested by (UnitedHealth Group’s) recent moves in Maryland and Washington. Those with little Medicaid footprint may find it harder to be competitive.”
UnitedHealth Group is looking at re-entering markets to sell individual coverage under the Affordable Care Act after a several-year absence.
UnitedHealth’s UnitedHealthcare business was among several big health insurers including Humana and Aetna that stopped selling individual coverage under the ACA known as Obamacare. Many of these insurers who left the individual business were unable to successfully manage the rising costs of uninsured Americans signing up for coverage.
Today, UnitedHealthcare sells coverage on the ACA’s public exchanges in only three states: Massachusetts, New York and Nevada. But the insurer confirmed it has filed to re-enter ACA’s exchanges in Maryland and Washington states.
“As the exchanges have matured and stabilized, we intend to offer exchange plans in those states where we can provide an efficient network and competitive product capable of driving sustainable value for consumers and our state and federal partners,” a UnitedHealth Group spokesman said. “We believe an exchange product, where sustainable, can complement our existing portfolio of public and private options which are capable of providing universal coverage to all Americans.”
