Recently, there was some speculation (read: outright panic) over whether or not 96 of our 159 counties would have insurance plans available on the Patient Protection and Affordable Care Act (PPACA) exchanges in 2018. Last week, Blue Cross Blue Shield submitted proposed rates for all areas of the state to the Office of Insurance and Fire Safety Commissioner, according to the Macon Telegraph:
The Georgia insurance department had asked insurers that want to offer exchange coverage to submit their proposed rates by May 16, while the federal deadline is June 21.
The proposed rates will be publicly available after June 21, the agency said.
Submitting rates is only the first step in the process, however, as Commissioner Ralph Hudgens has to sign off of them, and Blue Cross Blue Shield still can opt to withdraw at any time. This latter point is important, given the current state of PPACA and the plans to repeal it.
Blue Cross Blue Shield’s signaled commitment to the Georgia exchanges in 2018 comes at a time when the Trump Administration and House Republicans have filed a motion in federal court to hold a case for 90 days regarding the constitutionality of cost-sharing reductions in PPACA. The purpose of the cost-sharing payments is to reduce the out-of-pocket expenses of low income consumers, but Republicans in Congress have refused to fund the payments in the past, leading to the Obama Administration funding them without a specific allocation. House Republicans sued the Obama Administration in 2014 for illegally authorizing the payments, and a lower court agreed with them.
A decision on this question would considerably calm insurers like Blue Cross Blue Shield because for now there is no guarantee companies would be reimbursed for cost-sharing payments after May 31. The Trump Administration has committed, however, to funding the reimbursements through May. If the motion to delay is granted, insurers planning to participate in 2018 may fear the marketplace is too unstable and pull out. In the case of Georgia, such a move would leave much of the state without a participant to offer insurance plans to consumers required to purchase plans under current federal law.
The Trump Administration has argued that payments beyond May will not be necessary due to the president’s plan to repeal PPACA. However, the likelihood that any repeal legislation would be passed by the Senate, reconciled with the House-passed repeal bill, and signed into law by June 1 is fantastically optimistic. The Senate’s 13-member working group has not yet provided a concrete agenda for what that chamber’s bill will include. On Sunday, Senate Majority Leader Mitch McConnell suggested that a vote on repeal legislation may not happen until sometime in July.
Meanwhile, Blue Cross Blue Shield has released a “wish list” for PPACA repeal that includes familiar portions of the current law, such as continued protections for people with pre-existing conditions, no lifetime cap on benefits, and no higher premiums based on gender — while enforcing stricter penalties on individuals who don’t maintain insurance coverage. (Doesn’t this sound a lot like the current law?) Republicans have made repealing the requirement to purchase insurance a keystone of their repeal plans, and in the recently-passed House version, some of these other items were rolled back or removed.
Given that other large insurers, like Aetna and UnitedHealthcare, have already quit participating in PPACA exchanges, Blue Cross Blue Shield becomes all the more powerful when it comes to shaping the Republicans’ plan to replace PPACA. It will be fascinating to see how much of the company’s blueprint ends up in the Senate bill.