Virginia Obamacare rates set to fall next year

RICHMOND — The cost of individual health insurance is set to decline sharply next year in Virginia, with companies proposing double-digit percentage declines in their latest filings with the State Corporation Commission.

While most Virginians get coverage through large employers' group plans – typically regulated through the federal Employee Retirement Income Security Act (ERISA) – more than 313,600 Virginians buy these individual Affordable Care Act policies.

The reductions will bring the average per-person monthly rate in the Richmond area down to anywhere from $524.26 charged by the largest plan, Anthem Blue Cross Blue Shield's statewide HealthKeepers, after a proposed average reduction of 10.5%, to $438.21 for Cigna Health and Life Insurance Co. after a 19.6% decline.

One Northern Virginia-only plan, Group Hospitalization, with just over 800 customers, is proposing a $1,116,04 average monthly rate, a 24.3% reduction.

Those are gross rates, before accounting for the subsidies the Affordable Care Act provides for people in households with incomes as much as four times the poverty level. The subsidy is largest for people closest to the poverty line and declines as incomes rise.Anthem, UnitedHealthcare, other major insurers are running billions behind in payments to hospitals, doctors

The State Corporation Commission's Bureau of Insurance must still review them and determine if they are fair to people buying insurance and will generate enough money for insurers' reserves to pay claims.

Last year, the Bureau rolled back and in some cases reversed the proposed rates filed by almost all the insurers.

"It's good news that rates will be declining," said Doug Gray, executive director of the Virginia Association of Health Plans, a trade association for health insurers.

He said it reflects the launch of Virginia's reinsurance program for Obamacare individual and small business plans, as well as Congress' decision to extend the term for federal Obamacare subsidies through the new Inflation Reduction Act. The reinsurance program covers insurers when claims in any single case exceed a preset amount.

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"They gave the plans some certainty," Gray said.

The reinsurance program taps federal Medicaid funds and Virginia's general fund – the pool that state tax collections flow into – to fund the program.

The idea is to step in for the costliest cases, said Del. Mark Sickles, D-Fairfax, who sponsored the idea.

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"It means insurers can know their worst case scenario and price accordingly," Sickles said. He added that the costliest cases are also the hardest for insurers to predict, even when they cover as many people as the 140,000 in HealthKeepers, the largest plan in the state.

The reinsurance program "has allowed us and all other carriers to lower premiums for individual plans through the exchange next year," said Dale Gauding, spokesman for Sentara Healthcare, which offers the Optima Health Plan, covering more than 35,000 Virginians. Optima is proposing a 20.9% reduction in its average premium.

"Reinsurance reduces financial risk for carriers by covering a portion of high-cost claims, which allows for lower rates," he said.

Denise T. Ward, spokeswoman for Anthem Blue Cross Blue Shield, said: "Our filing reflects our experience and ability to deliver on behalf of consumers in this market."

Sen. Tim Kaine, D-Va., talking to the Richmond Times-Dispatch editorial board last week, said the extension of subsidies for Affordable Care Act coverage will be one of the most important elements in the Inflation Reduction Act to ease the pressure of rising prices on family budgets.