All Georgia Counties will have an Insurance Exchange Provider in 2018

According to Georgia Health News, Blue Cross Blue Shield of Georgia will offer insurance on the Affordable Care Act exchange in 2018 in the counties that have no other options, ensuring that all Georgians who rely on the exchange to purchase health insurance will have the ability to purchase plans. Commissioner Ralph Hudgens announced the agreement today after two months of negotiations with BCBS. In June, BCBS had signaled its intent to leave the exchange market in Georgia due to uncertainty with the repeal and replace efforts at the federal level.

Of course, there’s a catch:

BCBS will be the sole provider for 85 counties in 2018, most of them rural. However, BCBS intends to pull out of the other 74 counties where another insurer is present, presenting those customers with fewer options — if any. This includes the Atlanta market.

Hudgens apparently brokered the “deal” with BCBS by holding firm on a threat that if it exited the exchanges in the counties with no other option then the insurer would be barred from the market for five years. Not immediately clear is whether or not that would have applied to Georgia’s non-individual insurance markets (employer-based, Medicare Advantage, and supplemental Medicare).

BCBS is the only health insurer offering coverage on the exchange in all 159 counties in the state for 2017, where the company serves 300,000 of the 490,000 Georgians who purchase health insurance through this market. It is by far the private health insurer with the most customers over all markets operating in Georgia, and in rural areas, BCBS often functions as a monopoly, able to set its reimbursement rates with hospitals, which are essentially obligated to acquiesce.

In a statement, BCBS reiterated that with the uncertainty in the market (read: will the President follow through on his threat to quit paying the Cost Sharing Reduction Payments, or CSRs?), it was impossible to make a long term commitment to the market.

The Senate has committed to holding HELP Committee hearings on health care reform in September, during which the future of CSR payments is sure to be a hot topic. Those in the know say whatever is to be done to shore up the exchanges needs to be done by the end of September so that insurers can be prepared for open enrollment in November. That is an extremely tight deadline, given that any changes would have to pass both the House and Senate, be reconciled, and then be signed by the President (or not).

Meanwhile, next installment of CSR payments comes due on August 21st, so President Trump must decide soon whether or not he’ll make that payment. If not, we can expect most (all?) insurers to exit the exchanges. Of course, while that will accomplish the President’s stated goal of letting Obamacare “scream death,” it will also yank insurance away from millions — and Republicans not named Trump are all too aware those folks will not blame the Democrats if that happens.