Obamacare exchange hangs on in Georgia; Blue Cross may stay next year

Obamacare in Georgia has survived another day.

The last insurance company to still serve patients on the Affordable Care Act exchange in all regions of the state says it won’t back out, at least not yet.

Blue Cross Blue Shield of Georgia, the only remaining company to serve all 159 counties in the state, has filed its annual plans for next year’s insurance market. In its initial filing, it submitted plans for the entire state, said spokeswoman Debbie Diamond. Big questions remain, however, including how much the company will charge.

» MORE COVERAGE: The latest on healthcare in Georgia

Without Blue Cross, 96 counties in Georgia would have no insurance plan on the exchange. Other private insurance would still be available, but it wouldn’t be subsidized for the lower-income patients like exchange plans are.

Companies across the nation have been wavering on their participation, and this spring some analysts roiled the markets saying Anthem, the parent company of Blue Cross Blue Shield of Georgia, was leaning toward pulling back.

“Oh wow,” a relieved Kirk Lyman-Barner said on hearing Friday’s news from a reporter. An insurance broker in Sumter County, Lyman-Barner’s clients are mostly low-income patients on the Obamacare exchange and would be unable to afford private insurance if Blue Cross withdrew from the subsidized market, he said. “That was my biggest fear.”

But this is hardly the end of uncertainty for rural patients.

Leaders in Congress and President Trump are working to repeal Obamacare altogether. It's unclear how those efforts will proceed. The bill passed by the House has yet to be sent to the Senate and the Congressional Budget Office has yet to provide an estimate of its impact.

In the mean time, the Trump administration has broad powers to undermine the exchange, and has used a couple of them. Trump has hinted at endangering some cost-sharing subsidies. And on Monday Trump administration lawyers are scheduled to participate in a hearing defending Obamacare subsidies against Republicans in Congress, but it’s unclear what they’ll say in its defense, if anything.

Even if Obamacare stays in place, Blue Cross’s decision can still change, as negotiations between insurers and the state continue over the coming months.

More immediately, there is the question of rates the company will charge Georgians. The state and Blue Cross will not release the company’s proposed rates until the end of June, when all companies have a deadline to file. If rate increases are too high for people to afford, then that will likely damage the market.

“Ninety-five percent of my clients all receive subsidies, so without that they could not afford it,” said Lyman-Barner.

Several states have seen double-digit rate increases this year. And that’s on top of rates for premiums and deductibles that were already increasing to distressing levels, especially for patients who have incomes of around $50,000 a year and up.

“Some of it’s Obamacare and some of it’s Trumpcare,” said Cynthia Cox, associate director of health reform and private insurance at the Kaiser Family Foundation, a research organization. “In Obamacare the premiums in the first two years came in too low. There weren’t enough healthier young people signing up. Insurance companies have had to raise their rates significantly over the last year or so…It’s a like learning to ride a bicycle, in a market that’s not completely formed.”

Then under Trump, the administration cut funding for advertisements that have been effective in reminding younger, healthier patients to sign up. And there are cost sharing subsidies that the Obama administration paid out that the Trump administration may decide not to. That makes the companies wonder whether to raise prices to prepare for such problems.

“Some are getting cold feet,” Cox said. “Some are leaving, some raising premiums and pricing for that uncertainty.” It wouldn’t be a surprise to also see increases in Georgia premiums, she said.

One way or the other, Lyman-Barner said, the whole community needs for residents to be covered with health insurance. “People will go without getting medical services and treatment that they need if they don’t get covered,” he said. And if they just go to the hospital then the hospital takes on bad debt. “The hospital can only handle so much, it would have put tremendous pressure on all the providers.”