Insurers shun Middle Georgia Obamacare market

Across the country, people who get their health insurance through Affordable Care Act marketplaces will face fewer choices and higher sticker prices when enrollment starts next month. In Middle Georgia, the trend is the same.

In Macon-Bibb County, only two insurance companies — Anthem (parent of Blue Cross and Blue Shield of Georgia) and Humana — will offer insurance to individual buyers who use the health insurance exchange created under the Affordable Care Act, known as “Obamacare.”

Macon-Bibb shoppers could choose among plans from seven companies in 2015.

That’s according to data and estimates compiled by Avalere, a health care consulting firm, and published by the Associated Press.

In Houston and Peach counties, only two companies will offer plans, down from a high of six companies.

In Crawford, Jones, Monroe and Twiggs counties, like much of the rural Deep South, only one company will offer policies. In Georgia, Anthem will dominate rural areas.

About 16,600 people across Macon-Bibb and neighboring counties were enrolled in exchange plans in 2016, according to Avalere’s estimate.

Across those seven counties, the sticker price of a benchmark mid-range plan for a theoretical 50-year-old nonsmoker went as low as $386 per month in 2015, but will cost about $515 next year, Avalere estimates.

Across the state, Avalere estimates premiums will range between about $339 and $722 next year.

Though very few customers will pay that price. Most are eligible for an income tax credit on a sliding scale to cover the cost of premiums.

But the primary reason that companies no longer want to sell on the individual marketplaces is simple: it’s not profitable, according to Larry Walker III, a Perry insurance agent.

“You can be 400 pounds, diabetic, with hepatitis C and they still got to take you,” Walker said.

He also said that there are some folks who sign up for insurance only when something bad happens.

Obamacare is supposed to guard against that by opening enrollment only at a set time. But exceptional sign-ups are allowed for folks who lose insurance due to a so-called “qualifying event” like a job loss or divorce.

“Well, people are … there’s a lot of abuse of the qualifying events,” said Walker. He said some people sign up only once they know they are going to need to make a big claim.

“It contradicts the whole concept of insurance and shared risk,” said Walker, who is also a Republican state lawmaker.

Of course, part of the point of Obamacare was to help make sure people with preexisting conditions could afford insurance. Generally, what hasn’t come through are the healthier customers who would make the pool of customers generally less risky to insure.

When exchanges first opened, high-need individuals who lacked insurance “flocked to the market,” said Caroline Pearson, senior vice president of Avalere.

Since then, healthier folks have failed to follow.

“Enrollment has fallen short of projections and growth has really stagnated. We’ve been left with that high-need population,” said Pearson, speaking of the country broadly as a whole.

When Aetna left the Georgia exchange this year, it cited financial losses.

But the federal Department of Health and Human Services pushes back against a gloomy interpretation of the health care exchanges in Georgia.

“Thanks to financial assistance, the large majority of current marketplace consumers in Georgia will be able to find plans with premiums between $50 and $100 per month,” said HHS Secretary Sylvia M. Burwell in a press release.

The same document says that efforts to “undermine” the ACA, such as Georgia's lack of Medicaid expansion and congressional actions to block funding for the law, contribute to higher premiums.

This story was originally published October 27, 2016 at 5:36 PM with the headline "Insurers shun Middle Georgia Obamacare market."