Oscar Health files to expand insurance coverage in several states

Humana, one of four insurers now serving Bexar County, announced earlier this year that it planned to pull out of the exchanges completely. The Senate is weighing a new plan and may vote on it next week. That could put four counties at possible risk of having no insurer next year, according to Kaiser, although that is uncertain because a different insurer, Centene, has announced it is expanding in the state.

While insurers and consumers have experienced a bumpy ride within the Obamacare program, the situation has been far more stable for the 156 million Americans with employer-sponsored health insurance.

As Republicans move forward with an effort to repeal and replace the Affordable Care Act, insurers are faced with mounting uncertainty over the health care landscape; for some, instability and damaging costs have deterred participation, while others see opportunity. The Trump administration put off a court decision on the legality of the ObamaCare subsidies last month, though it will continue to fund them until a final decision is made.

Anthem, a major for-profit insurer offering Blue Cross plans in 14 states, has already chose to pull out of OH but would not disclose its projections elsewhere.

Oscar, known for its strong tele-medicine presence and digital-friendly website, also wants to sell individual and small business policies independent of the landmark health care law, according to the announcement. "We may have to exit certain markets because those markets are not sustainable", Anthem's chief executive, Joseph R. Swedish, said in an interview with CNBC last week.

Enough insurers are planning to sell coverage on the Affordable Care Act's insurance exchanges next year to keep them working - if only barely - in most parts of the country.

But while the overall market is worsening, "there is a lot of variation by local market", said Dan Mendelson, Avalere's president. The company said the exorbitant rate increase is necessary to remain in a market where all other insurers have fled.

Avalere found that proposed premiums for the most popular type of exchange plans (silver) are expected to rise 18% on average compared to 2017.

The Avalere report was based on the review of early filings in seven states and the District of Columbia. The Trump administration and Congress have yet to commit to critical funding for subsidies worth billions of dollars to low-income individuals.

Insurers "are going to build all of this uncertainty into their rates to the maximum extent to protect themselves", Ms. Corlette said. While its losses have narrowed, Oscar lost about than $200 million past year and said that other changes were needed to stabilize the market.

But conditions have improved, Schlosser said. "They know they need to make the market work".

  • Leroy Wright