Obamacare chaos: Insurers may flee before new plan is put in place

Tom Price in 75 seconds
Tom Price in 75 seconds

When it comes to dismantling Obamacare, repeal and replace is looking more like repeal and delay.

But repealing Obamacare before a replacement plan is hammered out could wreak havoc in the individual insurance market. More insurers could flee or jack up their prices for 2018.

President-elect Donald Trump and Congress say they plan to repeal Obamacare early next year, but it will likely take months, if not years, for lawmakers to draw up a replacement plan.

Insurers, however, don't have time to wait around and see if they like what Republicans propose. They must submit their initial rate filings for 2018 to state regulators in May and sign contracts by September.

"You have an unacceptable situation," said Robert Laszewski, who runs Health Policy and Strategy Associates. "Carriers will go on the defensive. They will either pull out or dramatically raise rates again."

Related: Americans divided over repealing Obamacare

If Obamacare were a stable, profitable market, the delay might not be that big a deal. But the individual exchanges are troubled, with many insurers already questioning their participation after losing hundreds of millions of dollars a year.

The number of insurers on the exchanges dropped by nearly 25% for 2017, while premiums skyrocketed 22%, according to federal data. Large insurers, including UnitedHealth (UNH) and Aetna (AET), are drastically scaling back their participation next year. And most of the small co-ops set up by the federal government to provide more choices have failed.

Five states will have only one insurer in 2017, up from a single state this year. Nearly 20% of enrollees will only have one insurer to choose from next year, according to Kaiser Family Foundation estimates.

The Obama administration was working with insurers to address their concerns and stabilize the market. But that won't happen under Trump, who has long vowed to get rid of Obamacare as soon as he takes office next month.

Related: How Trump's health secretary pick would replace Obamacare

Insurers aren't saying much publicly. Most of those contacted by CNNMoney declined to comment. But they are making it clear to lawmakers what kind of crisis a delay might hatch, said Laszewski, who serves as a consultant for several carriers.

"The government shouldn't assume they'll participate," he said.

What insurers will do in 2018 will depend in large part on how they've fared on the Obamacare exchanges so far, said Paul Lambdin, a managing director focusing on insurance exchanges at Deloitte Consulting.

Many are struggling. Central to their problems is that enrollees were sicker and costlier than many insurers expected. So the rates these insurers set did not cover their expenses, leading to losses and a hike in premiums for next year.

This problem could get worse in 2018 if healthy participants leave the market, figuring the Trump administration has repealed Obamacare anyway. That will leave a pool of sick and expensive enrollees, likely leading insurers to further hike rates.

Related: Democrats plot tactics to thwart Obamacare repeal

"Insurers already on the edge will pursue exiting markets more quickly," said Sam Glick, partner at Oliver Wyman, a consulting firm. He noted that the companies don't like uncertainty. But "insurers that doubled down on the individual market will continue full steam ahead."

Some carriers, such as Molina Healthcare (MOH), and several Blue Cross Blue Shield plans, are doing well since they are more familiar with dealing with low-income and individual market enrollees. Others may stay in because they want to remain in the individual market in the post-Obamacare world.

Molina, which has traditionally catered to the Medicaid market and now covers more than half a million people in the individual market, is one firm that has done well under Obamacare. CEO J. Mario Molina expects to continue providing coverage while lawmakers come up with a replacement plan.

"We've been dealing with government programs for 35 years," he said. "We will be flexible and adaptable to whatever the government needs."

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