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U.S. NEWSSaturday 27 February 2016

American Living:

Insurer warnings cast doubt on ACA exchange future

TOM MURPHY forcing around 750,000 tle campfire that’s going up when the exchanges ing into a new market.
AP Business Writer people to find new plans. to grow, but right now it opened a few years ago. Medical costs almost tri-
Political uncertainty isn’t More insurer defections needs a little more oxygen Healthy customers have pled to more than $181
the only threat to the Af- would lead to fewer cov- or kindling,” said Katherine been slower to enroll. million through the first nine
fordable Care Act’s future. erage choices on the ex- Hempstead, director of Insurers say they’ve also months of 2015 for Maine
been hurt by customers Community Health Op-
The HealthCare.gov website, where people can buy health insurance, is displayed on a laptop who appear to be waiting tions. Outpatient services
screen in Washington. Health insurers are reporting steep losses from their business on the Af- until they become sick to like expensive drug infu-
fordable Care Act’s insurance exchanges and some are considering dropping the business. But buy coverage. The compa- sions and orthopedic pro-
experts also see signs of growth in this critical component of the federal law and ways to make it nies blame liberal enforce- cedures for hips and knees,
better. ment of the ACA’s special in particular, hurt the insur-
enrollment exceptions. ance cooperative.
(AP Photo/Andrew Harnik) The law provides an annual CEO Kevin Lewis isn’t sure
enrollment window for sev- yet whether they need to
Cracks also are spreading changes and could even- health insurance coverage eral weeks starting in the consider that higher-than-
through a major pillar sup- tually undermine the law, programs for the Robert fall. This is the main chance expected use in setting fu-
porting the law provided the next presi- Wood Johnson Foundation, most people have to enroll ture rates or if it was pent-
Health insurance exchang- dent wants to keep it. a nonpartisan organiza- or change coverage. up demand from people
es created to help millions However, insurance ex- tion that has assisted state But customers can enroll who haven’t had cover-
of people find coverage perts aren’t writing an ACA governments on ACA insur- outside that window if in- age.
are turning into money-los- obituary yet: Enrollment is ance expansions. surance needs change be- Community Health Options
ing ventures for many insur- growing and appears to cause they’ve moved, got- covered nearly 71,000 peo-
ers. getting younger in some BALANCING ACT ten married or had a child, ple as of late September.
The nation’s largest, Unit- markets, a crucial factor The biggest problem with among other exemptions. That’s up 78 percent from
edHealth Group Inc., could for stability. Insurers also are the exchanges reflects a Exchanges have not been the end of 2014, and Lewis
lose as much as $475 million learning more about their basic insurance rule: Insur- asking for birth certificates, said the customer base is
on its exchange business new customers and adjust- ers need healthy, premi- marriage licenses or other getting younger, which is
this year and may not par- ing their coverage to do um-paying customers to proof of these life-chang- important because those
ticipate in 2017. Another better financially. The future balance claims they cover ing events. Insurers say that customers generally con-
major insurer, Aetna, has of the exchanges depends from the sick. Insurers have leaves them vulnerable. tribute fewer expenses.
questioned the viability of on whether those improve- struggled in many mar- The Montana Health Co- Now the insurer has to hit
the exchanges. And a doz- ments continue and some kets because people who Op had a severely ill cus- the right balance of rais-
en nonprofit insurance co- other, big worries ease. couldn’t get coverage pre- tomer in a hospital sign up ing rates enough to cover
operatives created by the “Sometimes I think of viously due to a condition for its coverage in October claims but not so high that
law have already closed, (the exchanges) as a lit- were among the first to sign and then drop a $250,000 it scares away those newer
bill on the insurer. CEO Jerry customers.
Dworak said he asked the “If higher prices prompt
exchange operator for de- healthier people to bail, it
tails on whether the patient won’t be long until it unrav-
had a legitimate reason for els,” Lewis said.
the special enrollment. The
exchange would only say THE FUTURE
that the patient changed Challenges remain for
ZIP codes. companies selling cover-
“They’ve got to do some- age on the exchanges.
thing about the special en- Some government pro-
rollment because we just grams that provided tem-
got killed on that,” Dworak porary financial support for
said. insurers as they set up their
exchange business are
HIGHER COSTS winding down.
Many insurers also are At the same time, pre-
struggling with higher-than- miums are rising in many
expected costs in general. markets, and that makes
Part of that comes from the high-deductible cov-
either starting an insur- erage found in many ex-
ance business from scratch, change plans a tough sell
as the co-ops did, or break- for healthy people.q