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Insurance commissioner says state’s demographics driving premium increases in ACA exchange

CHARLESTON, W.Va.¬†—¬†State Insurance Commissioner Mike Riley says approximately 14 percent of the state residents who are part of the West Virginia health insurance exchange under the Affordable Care Act will see the largest sticker shock in the next plan year.

Sign-up starts Tuesday under the exchange which includes Highmark Blue Cross Blue Shield and CareSource.

Eighty-five percent of the approximately 25,000 state residents who get their health insurance under the exchange receive a government subsidy but those who don’t will see a 32 percent increase in monthly premiums, according to information released last week by the federal Department of Health and Human Services.

The number of claims is driving the increase in the exchange, Riley said.

“More claims are coming than premiums being received. Certainly this is a new demographic of folks in the past that did not have insurance coverage. As their coming in and obtaining this coverage they are using it,” Riley said.

Highmark told MetroNews “Talkline” Host Hoppy Kercheval last week its ACA population is sicker.

“The exchange members are 85 percent more likely to have had a cancer diagnosis in the last year, 88 percent more likely to have coronary artery disease, 69 percent more likely to have hypertension, 80 percent more likely to have COPD and 110 percent more likely to have chronic kidney disease,” the company said.

The claims follow the state’s demographics, Riley said.

“We’re not necessarily the healthiest state or youngest state in the world,” he said. “This new population appears to have more claims and more needs out there.”

Riley doesn’t see the rates coming down any time soon because he doesn’t anticipate any other companies besides Highmark and CareSource being part of the exchange.

“We’re at a position where we have to stabilize the market. Until rates became adequate there’s not going to be a whole lot of people interested in jumping in,” Riley said.

Highmark offers the exchange in all 55 counties. CareSource was in 10 counties in 2016 and will have 32 counties in 2017. Riley is hopeful CareSource will be in all 55 counties in the 2018 plan year.

Open enrollment on the exchange at healthcare.gov begins Tuesday and continues through Jan. 31, 2017. Dec. 15 is the deadline to enroll or make changes to plans for coverage to start on Jan. 1.

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