Originally Published: October 16, 2016 6:05 a.m.
See Related Story
A marketplace suggests a place to shop – be it for designer shoes, a prom gown, or health insurance.
Do you want pink heels, tulle fabric, or a high or low health insurance deductible?
In a marketplace, one thinks of a plethora of preference and price comparison, many items available in many colors and sizes.
If that marketplace becomes the only place to shop, and sells just one product, such as a sole health insurance plan, the customer suddenly has no bargaining chip on price. Add to that a financial penalty if you opt not to buy in that marketplace.
Just such a scenario is befalling some 10,000 people in Yavapai County now enrolled with the Health Insurance Marketplace of Arizona, the state’s answer to the federal Affordable Care Act implemented in Arizona two years ago. The sole 2017 marketplace provider for Yavapai County, and 12 other of the state’s 15 counties, will be Blue Cross Blue Shield of Arizona, confirmed Stephen Briggs, spokesman for the state Department of Insurance.
In the last three or four months, Briggs said the insurance marketplace has been in flux as the bulk of current marketplace providers opted against participation in the coming year.
The reduction in marketplace choice for the coming year – statewide there will be just two other providers – is expected to impact thousands more who need to enroll or face the potential of crippling medical bills and large income tax penalties. In Yavapai County, 18 percent of the 220,000 population still remain uninsured, according to local health officials.
State and local health officials said there are some 200,000 people now with health coverage through the marketplace, and based on requirements of the federal law that should at least double next year.
The 2016 penalty expected to remain for the coming year is $695 for an adult and $347.50 for a child, or 2.5 percent of a household income, whichever is higher. The penalty is imposed through the federal income tax process.
Though the shakeup is certainly a source of concern for potential customers, Blue Cross Blue Shield of Arizona is a reputable insurance company accepted by most doctors, said David McAtee, a certified application counselor with the Community Health center who assists individuals and families select appropriate insurance plans to comply with the federal Affordable Care Act. McAtee also serves as the public affairs officer for the Yavapai County Community Health Services Department.
As for price, McAtee admits that remains an unknown.
For this year, a family of four with an income of about $40,000 paid about $250 a month for a plan with a $6,000 deductible. If they upped the payment by $100, the deductible dropped to $2,000 a year, McAtee said.
Criteria for the marketplace is based on four factors: number of persons in a household, family income, age, and whether or not those to be insured are smokers, he said.
Even with this switch, McAtee said the likelihood is a majority of participants will get some subsidy. For those without insurance who earn more than $100,000, and therefore do not qualify for subsidies, the marketplace at least offers a way to get coverage, albeit at prices higher than they might wish to pay, he said.
Blue Cross Blue Shield of Arizona officials explained their decision to remain in the marketplace at least for the coming year is rooted in its 75-history of providing Arizonans with health insurance options.
Still it comes with financial risk, they said.
In the last two years, President and CEO Richard Boals said the company has incurred $185 million in losses due to individual marketplace plans. He, and other insurers, say they hope government leaders and lawmakers work with the industry to “stabilize the market and put long-term fixes in place.”
The company has filed a request with the state Department of Insurance for a 51.2 percent premium increase. Final reviews, and rates, have yet to be determined.
Aetna officials said the company dropped out of the marketplace in August because it could no longer sustain its losses – a total of $430 million since January 2014.
Aetna Chairman and CEO Mark Bertolini said 55 percent of the company’s new, 2016 marketplace customers required high-cost health care.
“As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision,” Bertolini said in a news release. “Providing affordable, high-quality health care options to consumers is not possible without a balanced risk pool.
“ … We will continue to evaluate our participation in individual public exchanges … and may expand our footprint in the future should there be meaningful exchange-related policy improvements.”