Anthem Insurance Company Will Return to Obamacare in Virginia
It will offer exchanges in 68 counties.
In August, health insurance company Anthem, the nation’s second-largest health insurer, decided to leave Obamacare exchanges in Virginia due to “uncertainty about the future of Obamacare” due to “an unbalanced risk pool.”
Anthem changed its mind on Friday and has decided to stick it out in parts of the commonwealth that would have had no insurers for the residents.
Anthem in a statement said its “decision will positively impact up to 70,000 Virginians—many of whom would not have had access to important health care coverage.”
“Anthem will remain focused on developments in the individual marketplace and will continue to advocate for solutions that will stabilize the market and allow us to once again offer individual insurance coverage throughout the state of Virginia in the future,” the company said.
However, to date Anthem overall has announced plans to significantly scale back its Obamacare business in 2018 in nine of the 14 states where it currently sells such individual market plans.
Anthem decided it “will sell Obamacare plans on and off the exchange in 68 counties.” This will include 63 counties that would have been without any insurance company selling plans. From The Washington Examiner:
Several insurers have left Virginia, causing counties to become empty at times. The most recent change came from Optima Health, which decided to offer fewer plans than in 2017 after previously saying it would offer plans in every state. Insurers have said that they have suffered significant losses by participating in the exchanges and they have said too much uncertainty is ahead in terms of what Congress will do to change the law and whether the Trump administration will make payments to insurers, known as cost-sharing reduction payments.
The payments were determined unconstitutional by a federal judge after they were challenged under the Obama administration, and Congress is considering appropriating them.
But like I said, Anthem wanted to get out of Virginia due to the instability. I don’t get why people find this so hard, but without a profit, a company cannot operate. Yes this includes the healthy industry. The Washington Examiner wrote at the time:
Without the funds, insurers would price their premiums higher for next year, but because they don’t know whether to expect the payments, they have said they are wary about doing business in the exchanges next year. Many of them already have claimed hundreds of millions of dollars in losses from selling the plans.
“Today, planning and pricing for [Obamacare]-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost-sharing reduction subsidies and the restoration of taxes on fully insured coverage,” Anthem said Friday. “As a result, the continued uncertainty makes it difficult for us to offer individual health plans statewide in Virginia.”
The news comes a few hours after I blogged about how Sen. Bill Cassidy (R-LA) believes he will gather the votes needed for his bill with Sen. Lindsey Graham (R-SC) to repeal Obamacare. The Washington Times reported:
“We are thinking that we can get this done by Sept. 30,” Sen. Bill Cassidy, Louisiana Republican who co-wrote the bill with Sen. Lindsey Graham of South Carolina, said Friday.
Republican leadership seemed to greet the bill with a shrug when it dropped this week, yet Mr. Cassidy said the idea “took off” during a Thursday luncheon that focused on health care.
The senator said his informal whip count stands at “48 or 49” GOP votes, suggesting they are close to the 50-vote threshold needed to pass a bill, using Vice President Mike Pence as a tie-breaker.
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Anthem Blue Cross has recently puled out of uber-progressive Santa Cruz County CA. If you like How your insurance you can keep your insu….. O, well, they will just blame this failure of ObamaCare on Trump and ‘Repugs.’
-“Anthem changed its mind on Friday and has decided to stick it out in parts of the commonwealth that would have had no insurers for the residents.”-
This is simply not true. There are a number of health insurance companies which provide coverage to the ENTIRE state of Virginia. The problem is that many people can not AFFORD the premiums for these policies. I hate to say this, but the private health care insurance industry is doomed. Health care costs are so high, that people can not afford them without insurance. I recently had a series of blood tests done by a national medical laboratory, something which I have done three times a year. The lab charged $485 dollars for the tests. Medicare paid the lab $65 on that $450 bill. And, the lab accepted it as paid-in-full. See the problem? The problem is the cost of health care. Most people, who have insurance, have no idea what doctors, hospitals, labs and other facilities actually charge for services and how little they will accept from the insurance company. If the lab only charged me $65 for the tests, then I wouldn’t need to pay the high health care insurance premiums that I have to pay for coverage.
You’re right on. Extending your logic, though, the reason that health care is so costly is that over half of the patients pay nothing at all.
No, the reason why healthcare charges is so high, is the third party payer system.
What happened as that insurers only pay an agreed upon price, for a particular service, or a percentage of the charged price. Healthcare providers raised their prices to a level where the percentage paid by the insurer allows them to make a profit. As an example take the average doctor’s office visit. The charge for the average office visit is now $70 [for GPs] and $150 [for specialists]. Most insurance plans require the patient to pay a co-payment. Usually it is ~$20 for the GP. The insurance company then pays the GP ~$18, for a total of $38 dollars. However, the uninsured patient often has to pay the full $70. Specialist office visits are similar, with a co-pay of $35-40 and an insurance payment of around $20. But, the insured usually has to pay at least $700 a month for the plan to cover 2-4 office visits a year.
And, there are a number of states which do not allow a medical service provider to bill the lower cost [the one paid by the insurer] to non-insured patients if they charge a higher cost for insured patients. This was put in place by legislatures to protect insurers, by forcing uninsured consumers into the insurance pool to offset costs.
Healthcare insurance is what has driven up healthcare charges. And, the largest healthcare insurers in the US are both government programs, Medicare and Medicaid.
One of the key points in my personal plan to fix health care is “best price for payment up front” — that is, all health care procedures must have a “cash up front” price, that must be their lowest-above-cost (fine to offer charity care at cost or below) and must be offered to everyone who pays this price at the time of service.
And of course they are my provider and of course I live in VA. Cheers, Obama comrades, premiums and co-pays are gonna be sooooo affordable now.
One issue with O-care is, unlike medicare or its counterpart medicaid who negotiate with health care providers for the price, (not really, they dictate how much they will reimburse), O-care does none of that. The providers tell O-care how much, then gets paid if the deductibles have been met leaving that huge inflated price to be paid by the unaware consumer who may never get to the stage where the insurance actually kicks in. A cash price sounds good, but when a provider needs such a large secretarial staff to bill the insurance, that guarantees best price over cost will be grossly inflated as well.