Eyes on Centene to fill void after Obamacare insurer bails on parts of Missouri

June 04--When certain insurance companies have bailed on the Obamacare exchanges in the past -- potentially leaving residents of entire counties without a single option for affordable health coverage -- an insurer has always stepped up to fill the void.

But it's unclear if any insurer will extend marketplace coverage to the 25 Missouri counties that will be left with no carriers in 2018, potentially leaving 67,000 people in the western part of the state without coverage options.

A series of actions undertaken by President Donald Trump's administration over the last five months has made insurers wary of the government-run marketplaces that have already exposed some to significant financial losses.

Chief among the insurers' concerns is whether the administration will continue to extend subsidies to help them provide coverage to consumers with low incomes who probably could not otherwise afford coverage. Without the subsidies, insurers have said they would exit the marketplaces.

While the uncertainty looms, the clock is ticking. The deadline for insurers to file rates with the federal government is quickly approaching.

Under President Barack Obama's administration, federal officials exerted pressure on other carriers to step up and fill what are known as "bare counties." That doesn't appear to be happening in the Trump administration, which has pledged to eliminate the Affordable Care Act.

That leaves the state to step up and exert pressure, something Sarah Luecke, a senior policy analyst at the liberal Center on Budget and Policy Priorities, says needs to happen. "Hopefully, the state ... is working to make sure people have options," she said.

But the state isn't saying much about what it is or isn't doing.

Missouri's Department of Insurance did not say whether it was trying to convince other health plan providers to cover the affected counties in western Missouri.

The department said it was "deeply concerned about the devastating impact" Blue Cross Blue Shield's plan to withdraw from a 32-county service area in western Missouri and part of eastern Kansas will have in parts of Missouri.

When asked about what it is doing to get carriers to extend coverage in those bare counties, the department's director, Chlora Lindley-Myers, said in an email statement: "We will continue to work with insurers and other stakeholders here in Missouri and our legislators in Washington to do all we can to assist these impacted Missourians as soon as possible."

If an insurer were to step up, the obvious candidate would be Clayton-based Centene. It's a leading provider of Medicaid managed care service in Missouri -- and it's come to the rescue in other states when other insurers have backed away.

And fast-growing Centene hasn't been shy about boasting of its successes on the health insurance exchanges. It has highlighted its financial success when other and much larger health insurers have faltered, losing millions of dollars to provide insurance to the newly formed individual market provided through HealthCare.gov.

As the nation's largest Medicaid managed care contractor, Centene is familiar with providing health insurance to low-income individuals, unlike larger commercial insurers who primarily deal with group health plans for employers.

Physician networks that Centene sets up for its Medicaid patients are the same ones that the company uses where it offers Obamacare plans.

Blue Cross Blue Shield of Kansas City said it was withdrawing because it could not continue to sustain losses it has experienced. Through 2016, the company said it incurred more than $100 million in losses.

"This is unsustainable for our company. We have a responsibility to our members and the greater community to remain stable and secure, and the uncertain direction of this market is a barrier to our continued participation," Danette Wilson, president and chief executive of Blue Cross Blue Shield of Kansas City, said in a statement.

Other carriers have exited Missouri, and other states, and there may be more departures. Anthem has said that it may quit providing coverage in Missouri and 13 other states, its entire Obamacare footprint.

Centene spokeswoman Marcela Hawn said the company would not comment about whether it will enter the Missouri exchange market.

Past officials have worked hard to make sure no counties were left without a carrier.

The former chief executive of HealthCare.gov, Kevin Counihan, told the Post-Dispatch that much of his job was spent making sure no county was left "bare."

"I would speak to a CEO of a health plan daily," Counihan said. "I committed that we would not have bare counties going into 2017 and we didn't have any."

Last year he spent up to eight weeks on the road visiting counties at risk of having no carriers on the exchanges. Maricopa County, Ariz., for example, appeared to be heading toward no carriers for this year. Centene filled the void.

"They came through when we needed them to fill Maricopa County. That was a very important relationship that we had," Counihan said.

Sabrina Corlette, a research professor at Georgetown Health Policy Institute, said the actions by the current administration are causing trepidation among carriers.

"I think what's holding back a lot of carriers is all the uncertainty at the federal level," Corlette said, citing the administration's failure to say whether it plans to extend the subsidies.

"We know they don't like uncertainty because uncertainty means risk."

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