When Missourians go to healthcare.gov to buy health insurance, they likely won't be shocked by double-digit increases this year, according to data filed Wednesday with the state’s insurance department.
Three existing carriers — and one new entry into the market — will offer plans with smaller increases than previous years. Two insurers offering healthcare.gov plans are asking for modest rate increases.
Healthy Alliance Life Insurance plans an average increase of about 4 percent, and Cigna’s plans will increase about 7 percent. Centene's Celtic Insurance plans an average decrease of 9 percent.
The rate filings will not be finalized until late fall.
Representatives of the Missouri Department of Insurance, Financial Institutions and Professional Registration can’t prevent a company from charging the proposed rates but can deem a rate increase “reasonable” or “unreasonable.”
Customers can comment on the proposed changes through the 30-day public comment period.
Though two of the three returning insurers are proposing premium hikes, they’re modest compared with last year’s average increases of nearly 40 percent. Those big increases were a result of a volatile political climate, Saint Louis University law professor Sidney Watson said.
Last year, President Donald Trump and the Republican-controlled Congress discarded several provisions of the Affordable Care Act, including subsidies that helped offset costs for companies offering plans on the exchange and the penalty for those who didn’t have an insurance plan. As those decisions were being made, insurers frontloaded their risk by raising their prices higher.
“I think what happened last year was everybody was uncertain what was going to happen in the marketplace, how state regulators were going to blocking of cost-sharing subsidies,” Watson said. “All that’s been worked out, so I think there must be less uncertainty out there.”
But Watson thinks the marketplace is far from stabilizing. In July, Trump announced a freeze on $10.4 billion worth of risk-adjustment payments to insurers, which help carriers provide coverage to all patients regardless of how healthy they are, a key provision of the Affordable Care Act.
Additionally, insurers keep dipping their toes in and out of the marketplace to see if they can be profitable with a new pool of customers, she said. That mean companies churn in and out of the exchange – and buyers are left trying to keep up.
"More the challenge here has been the change in carriers,” Watson said. “When the plan you got one year isn’t available the next — the carrier network you relied on changes when it’s a new carrier that comes in — that’s frustrating.”
One of those new carriers is Minnesota-based Medica, which is making its exchange debut in Missouri in 2019.
But just because there are four carriers on the exchange doesn’t necessarily mean most customers will have four providers to choose from. There were three insurers on the marketplace in 2018, but many counties outside urban areas were left with only one provider. According to Kaiser Family Foundation data, in 2018, 44 percent of marketplace enrollees in Missouri could only choose Cigna, Anthem or Centene plans, depending on which county they were from.
For example, Medica will only offer coverage in four counties in the Kansas City area, according to a press release from the company.
Preliminary filings don’t require insurers to show in which counties they will offer plans. More information about where plans will be offered will be available when rates are finalized in the fall.
Affordable Care Act supporters rallied against the rate increases Wednesday, saying they were evidence of Republican “sabotage."
“Until we stop the GOP’s war on health care, health-care experts predict that rates will keep rising,” Brad Woodhouse, executive director of advocacy organization Protect Our Care, said in a statement.
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