Blue Cross Blue Shield move leaves major medical hole in Columbus

Aug. 08--A decision by Blue Cross Blue Shield of Georgia to pull out of all but 85 of the state's 159 counties in 2018 looks to have a major impact on Columbus-area residents who aren't on company-sponsored or Medicare coverage plans.

The Atlanta-based health and medical insurer made the announcement Monday that it will neither be offering Affordable Care Act exchange coverage nor market-rate coverage to individuals off the federally subsidized exchange next year in Muscogee, Chattahoochee and Harris Counties. Those people with company-sponsored and Medicare health coverage that now offer Blue Cross will remain in those plans, it said.

In an agreement with the Georgia Department of Insurance, the insurer did agree to offer both on-exchange and off-exchange coverage to individuals primarily in rural counties that would have no insurance carrier otherwise. There are 85 counties in that group, including Troup and Meriwether counties just north of Columbus.

"For more than seven decades, Blue Cross Blue Shield of Georgia (BCBSGa) has served consumers in the individual market, and throughout that time our commitment remained the same: to provide access to affordable, quality health care," the company said in a statement issued through Debbie Diamond, its director of public relations.

"A stable insurance market is dependent on products that create value for consumers through the broad spreading of risk and a known set of conditions upon which rates can be developed," the company said. "We are pleased that some steps have been taken to address the long-term challenges all health plans serving the individual market are facing. However, the continued uncertainty makes it difficult for us to offer Individual health plans statewide. BCBSGa will remain focused on developments in the Individual marketplace and will continue to advocate for solutions that will stabilize the market and allow us to once again, offer individual insurance coverage throughout the state of Georgia."

Diamond said the company will be losing less than 5 percent of its total membership, or customers, in Georgia because of the decision.

The development comes with Republican and Democrat congressional leaders in Washington, D.C., unable to compromise one way or the other to improve or repeal the Affordable Care Act, which is often referred to as Obamacare. That includes a recent failed attempt by the GOP to approve a scaled-down, dubbed "skinny," repeal of the ACA, which was being promoted heavily by President Trump.

Carl Brown, an insurance broker with Brown & Associates in Columbus, on Tuesday called the move by Blue Cross Blue Shield of Georgia a "terrible situation" for people needing insurance and not covered by employer plans or Medicare. He already was beginning to receive calls from clients concerning the decision by Blue Cross Blue Shield to pull out of the market. He said the insurer is the only company available currently in Muscogee County off the federally subsidized exchange, although its off-exchange premiums are pricey.

"The average person probably will not be able to afford off the exchange because you're not entitled to any subsidies," he said.

A quick online check of non-exchange, market-rate quotes for male and female spouses 50 years of age found Blue Cross Blue Shield selling policies for about $900 a month with large deductibles. Under the exchange, a person with a lower income might have that reduced to $100 or less per month due to a federal subsidy, Brown said.

As it now stands, Blue Cross and insurer Ambetter are the only companies offering coverage within the exchange this year. Ambetter, operated by St. Louis-based Centene Corp., has already committed to remaining in the exchange in 2018, Brown said.

"That will probably be the only option," he said. "The bad part of it, though, is the networks remain the same. A hospital like St. Francis is not in the Ambetter network. That means if you go to St. Francis, you're going to pay 100 percent of the bill."

A likely scenario is that Ambetter will negotiate new terms with Columbus-area hospitals and physicians in light of it being the only health care-exchange insurer in the market in 2018.

Diamond said those policyholders whose coverage is being discontinued, including those in Muscogee County, will probably receive letters from the company in October.

"It will inform them that they are covered -- I want to stress this -- they are covered through the end of the year," she said. "But they'll have to look at the exchange for who is going to cover Muscogee next year."

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