South Florida’s 3 Obamacare providers file proposals to return in 2019

June 23--Obamacare isn't dead yet.

It might not have a great long-term prognosis but most of the Affordable Care Act structure familiar to Florida enrollees since 2014 looks all but certain to remain in place and available for 2019, based on statements by participating health insurers.

And if so, consumers will be able to renew coverage in an open enrollment period at the end of the year. It means HealthCare.gov and other enrollment websites will be open for business. And more than 90 percent of market enrollees will continue to receive premium tax credits to bring down the cost of insurance -- in many cases to less than $100 a month -- as well as to help cover costs of deductibles and copays.

The three companies that offered 2018 plans in South Florida are back -- market leader Florida Blue, which has been offering a wide array of plans to fit all budgets and circumstances -- plus narrow-network, lower-cost alternatives Molina Healthcare and Ambetter.

All three submitted 2019 rate proposals with the Florida Office of Insurance Regulation as required by June 20, along with four other companies that filed to sell plans in other areas of the state.

In all, rate increases proposed by eight companies offering ACA-compliant plans on and off of the exchange, average 8.8 percent, according to a news release by the state office late Friday afternoon.

That compares with a 17.8 percent increase requested a year ago by the same companies.

While any increase means higher premiums for consumers who do not qualify for government subsidies, known as advance premium tax credits, the vast majority of Obamacare consumers who do qualify will see a much smaller increase.

Of the 1.7 million Floridians who enrolled in 2018 marketplace plans, 92 percent qualified for subsidies and saw an average $595 monthly premium reduced to $70, according to data maintained by the Department of Health and Human Services. In the tricounty region, 762,000 are enrolled.

Analyzing rate proposals submitted so far in 10 states with earlier filing deadlines than Florida, the Kaiser Family Foundation estimated that premiums would increase 2 percent for consumers in those states who qualify for subsidies.

About 136,000 Florida consumers who bought plans off of the federal exchange but did not qualify for subsidies will face steeper premium hikes, as would consumers who buy plans outside of the exchange.

While the companies' proposed Florida rates are subject to change, and the companies can still change their minds about returning to Florida's market before open enrollment begins Nov. 1, the filings signal that all of the companies currently operating in Florida would continue to offer health insurance plans in 2019.

A new company has even filed to offer ACA plans in the state. Oscar Health, which currently sells plans in California, Texas and New York, on Thursday announced plans to expand into Florida, Michigan and Arizona in 2019.

Oscar spokeswoman Molly McNab said via email that Oscar initially plans to offer plans only in the Orlando area -- Orange, Lake, Osceola, and Seminole counties. But the company's expansion announcement stated that Oscar sees itself as one of the fastest growing insurers in the country with additional growth plans.

Molina Healthcare, a California-based company that began in Florida administering Medicaid plans in Miami-Dade County, has expanded its Obamacare presence in the tricounty region from about 500 narrow-network Health Maintenance Organization (HMO) plans in 2014 to 235,000 as of December 2017, according to the most recent enrollment figures available from the state Office of Insurance Regulation. The company expanded in 2017 to Duval, Hillsborough, Osceola, Pinellas and Polk counties and had 27,240 enrollees in those counties at the end of 2017.

Reached by email, Molina spokeswoman Laura Murray said the company "filed preliminary rates in Florida for the [federal] marketplace in the same counties where we currently offer marketplace plans."

She added, "We will continue to evaluate our participation on a market by market basis and we look forward to continue offering our members in Florida high quality, affordable options through the marketplace."

Market giant Florida Blue, which absorbed most of the policies abandoned by competitors Aetna, Cigna, UnitedHealthcare and Humana after Obamacare's first three years, plans to remain in all 67 Florida counties.

The company, which is owned by GuideWell Mutual Holding Corp., offers a wide variety of BlueOptions and BlueSelect preferred provider organization (PPO) and exclusive provider organization (EPO) plans at various price points, as well as its low-cost narrow-network MyBlue HMO plans.

Currently, it insures more than 1 million marketplace enrollees, spokesman Doug Bartel said Friday.

"We have submitted our rates [for 2019] and plan to offer a robust portfolio of products to meet the diverse needs of all 67 counties," Bartel said.

Officials from the third company that offers plans in South Florida, Ambetter, did not respond to requests for comment about its 2019 plans, but its parent company, Celtic Insurance Co., filed its rate submission with the state prior to the June 20 deadline, a search of the state filing database shows.

Other companies that filed rate proposals in Florida don't offer plans in the tricounty region, including GuideWell company Florida Health Care Plan, and Health First Commercial Plans, a Brevard County-based company affiliated with the Florida Hospital chain in Central Florida.

Nationwide, health insurers posted their strongest financial performance in the individual market in 2017, despite political opposition to the Affordable Care Act and the Trump administration's decision last year to end millions of dollars in cost-sharing subsidy payments to insurers, according to an analysis by the Kaiser Family Foundation.

"The strong financial performance suggests insurers on average priced their plans adequately last year," wrote Craig Palosky, Kaiser's communications director, on the foundation's website.

Not yet known is how ongoing Trump Administration efforts will affect the future viability of the marketplace, such as repeal of the individual mandate, a requirement that nearly all individuals buy health insurance or face tax penalties.

The repeal is expected to drive a large number of young, healthy adults out of the health insurance market completely, reducing the amount of money in the risk pool to fund treatment of older, sicker people and likely further driving up costs for consumers without subsidies, Kaiser reported.

Also, rising costs for nonsubsidized consumers are expected to push many to buy association plans and short-term plans promoted by the administration. These plans are not required to have the same level of benefits as ACA-compliant plans.

Association plans, promoted as easing the ability of small businesses to provide coverage for their employees, won't be allowed to deny coverage or charge more to people with pre-existing conditions, the Labor Department announced this week.

But short-term plans that provide coverage for a series of weeks or months do not comply with the ACA's rules that forbid canceling or denying coverage to consumers with pre-existing conditions, according to Kaiser.

The ACA's pre-existing condition protections are under assault by way of a lawsuit filed by 20 states, including Florida, that seeks to eliminate parts of the ACA that require sale of health policies to people with pre-existing conditions and prohibits insurers from charging more because of them.

About a quarter of non-elderly adults in Florida and the nation have pre-existing conditions that health insurers would have used as a reason not to cover them prior to the ACA's enactment in 2010, the Kaiser Family Foundation reported.

On June 7, Attorney General Jeff Sessions announced that the Justice Department would not defend the constitutionality of the ACA's protections of consumers with pre-existing conditions. The announcement sparked a political debate between supporters and critics of the Affordable Care Act that prompted Gov. Rick Scott this week to say he opposed removing the protections, despite the fact that his attorney general made Florida a party to the suit.

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