EDITORIAL: Insurance company failure could have implications for expanded Medicaid

Posted 10/27/15

WINhealth Partners, one of two carriers in the state to offer coverage in the exchange marketplace under the Affordable Care Act — otherwise known  as Obamacare — will suspend the sale of its health insurance plans for the remainder of 2015 and …

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EDITORIAL: Insurance company failure could have implications for expanded Medicaid

Posted

Failure of a health insurance company covering about 13,000 Wyoming policyholders was shocking news out of the Wyoming Insurance Department this week.

WINhealth Partners, one of two carriers in the state to offer coverage in the exchange marketplace under the Affordable Care Act — otherwise known  as Obamacare — will suspend the sale of its health insurance plans for the remainder of 2015 and will withdraw its participation in the insurance market for 2016.

After a finding by the Wyoming Insurance Commissioner that the company is financially at risk, t he courts have been asked to place WINhealth in receivership.

What happened in only the second year of the ACA? It’s all there in public documents.

The short answer is more insurers in the country, WINhealth included, lost money than made money under the ACA in 2014. WINhealth openly admits it went “all in” with selling coverage in the individual market under the federal exchange. The risk was there, and in the end, it took the company down.

The final straw fell on Oct. 1 of this year when the Center for Medicare and Medicaid Services (CMS) set the rate for one of the ACA’s supposed safety net payments to participating companies. Called the Risk Corridor program, it is the government’s way of sharing the risk with Qualified Health Plan issuers under the ACA.

If the issuing company’s premiums exceed claims costs by a certain amount, the company pays into the Risk Corridor program. If the premiums collected by the issuer fall short by a certain amount of the claims paid, the federal government makes a payment to the company.

Woe is the company that counts on the Risk Corridor payment making it whole or even coming close. According to CMS, a total of $362 million was paid into the Risk Corridor by insurers who made money under the ACA in 2014, while insurers who lost money sought $2.87 billion in Risk Corridor payments.

CMS announced Oct. 1 that it would pay 12.6 cents on the dollar of issuers’ losses. Those insurers who had booked the full Risk Corridor shortfall as a valid receivable were caught short. WINhealth had anticipated several million dollars from this program, and it didn’t materialize.

Taking notice, no doubt, are Wyoming legislators who almost certainly will take up again the question of expanding Medicaid in partnership with the federal government. Gov. Matt Mead backs Medicaid expansion with a waiver plan of Wyoming design. He says the state is foolish to pass on Medicaid dollars while the uninsured in the state struggle to access health care.

The Republican-controlled Legislature has so far balked at signing on for this optional element of the ACA to extend expanded Medicaid benefits to an estimated 17,000 Wyoming low-income citizens, even with the federal government paying 100 percent of the cost of expansion for the first three years.

The reason cited by Republicans? They say they don’t trust the federal government to hold up their end of the Medicaid financing bargain.

There is no direct relationship between Medicaid expansion and the federal risk-sharing with insurance companies under the ACA’s Risk Corridor program. But it’s hard not to imagine that the 12.6 cents on the dollar paid by the federal government wouldn’t evoke “We told you so’s” by Republicans distrustful of promised Medicaid cost-sharing.

At the same time, that shouldn’t be the last word.

Wyoming accepts federal Highway Trust Funds to carry the bulk of transportation system construction funding. We do believe that Wyoming state officials should try to shape an acceptable Medicaid expansion plan rather than simply refusing up to $100 million a year in federal funds.

Tailoring an approved Medicaid waiver plan in negotiation with the Department of Health and Human Services is different than going “all in” with an entitlement program where costs grow higher and higher each year.

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