Highmark Blue Cross Blue Shield considered pulling out of Obamacare exchange

CHARLESTON, W.Va. — Highmark Blue Cross Blue Shield almost pulled out of the state’s health insurance exchange after two years, company president Fred Earley told MetroNews Monday following the start-up of a new open enrollment period.

“It was pretty much a day-to-day decision working with the Insurance Commission on getting the rates moving forward to where we felt they needed to be or closer to where they needed to be was a big determinate,” Earley said. “I also give credit to the Insurance Commission for working with us to be able to stay in the market.”

Highmark Blue Cross Blue Shield has been the only company in the West Virginia exchange through the first two years of Obamacare. The company is raising premiums by 24 percent in the third year, Earley said.

“I wouldn’t say it’s been profitable and that’s part of the reason why you’re seeing the significant increases,” Earley said. “There’s also been some concerns on some of the factors that the federal government had put in place to offer some stability as you work to a point where this market is much more predictable. The funding for some of those factors has not come through and that has caused some very, very big concerns on our part and even a strong consideration on whether or not we could stay in this market.”

Ultimately the company decided it has a “social mission” to serve the needs of the citizens of West Virginia, Earley said.

“We need to get the pricing to the point where this segment of the market is self-supporting. Hopefully, we are getting to that point,” he said.

There were more than 33,000 state residents who signed up for insurance in the exchange last year. Earley expects the numbers to stay about the same or decline slightly. Subsidies from the federal government will help 80 percent of them pay the premium increases.

The people who have the insurance use it, Earley said.

“The utilization and access is higher than expected and that surge has not gone down at all,” he said. “We expect it to continue at that level.”

There is competition in the exchange this year in 15 counties for Highmark Blue Cross Blue Shield. CareSource will be an option for residents living in Boone, Brooke, Cabell, Clay, Hancock, Kanawha, Lincoln, Marshall, Mason, Ohio, Pleasants, Putnam, Wayne, Wirt and Wood counties.

“Competition in the market I believe is good for the consumer,” Earley said. “So we have no concerns about that.”

Earley said those getting insurance through the exchange are generally people in their late 40s, 50s and early 60s.

“They are employed working in a job that doesn’t offer benefits or working multiple part-time positions. They earn too much to be on Medicaid,” Earley said.

Highmark Blue Cross Blue Shield has made subtle changes to its different insurance plans. There are 15 plans off the exchange and 17 on the exchange.

The enrollment began Sunday and will continue through Jan. 31, 2016. Enrollment must be completed by Dec. 15 if coverage is to begin Jan. 1, 2016. Enrollment can take place online at healthcare.gov or by calling 1-800-318-2596.

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