Health Care

Obamacare enrollment ends with surprising results in Kansas and Missouri

Sheldon Weisgrau happily admits he was wrong about how many Kansans would purchase plans this year through the Affordable Care Act, which is commonly called Obamacare.

Weisgrau leads ACA enrollment efforts in Kansas. He and other analysts thought President Donald Trump’s decision to cut the open enrollment period in half would make it difficult, if not impossible, to match last year’s figure of 98,780 Kansans enrolled.

But when the dust settled after the Dec. 15 enrollment deadline, Kansas had enrolled 98,919.

“I don’t think anybody realistically expected this outcome,” Weisgrau said. “I just think it shows how many people really value having insurance.”

Missouri’s total of 245,580 enrolled also beat last year’s number, by about 1,000 people.

Nationwide the ACA enrolled about 8.8 million, just short of last year’s total of about 9.2 million.

Weisgrau said that Kansas saw about a month’s worth of sign-ups in the last week, which was evidence that consumers were hyper-aware of the early deadline despite the Trump administration also cutting the federal ACA advertising budget by about 90 percent.

He credited nonprofit health groups for filling in the gaps with their own ads.

The pace of sign-ups was brisk from the beginning, despite upheaval in the local market after Blue Cross and Blue Shield of Kansas City announced in late May it was exiting Obamacare.

That left thousands of consumers in and around Kansas City looking for new insurance plans to replace Blue KC coverage that will expire at the end of the year.

Blue KC officials said they lost too much money on Obamacare plans in the first three years after the law went into effect.

But the market appears to be getting friendlier for insurers following several years of premium increases, which are offset by federal subsidies for the majority of Obamacare purchasers.

Cigna, which sells Obamacare plans on the Missouri side of the Kansas City area, reported a slight profit on its individual health insurance business in the company’s third-quarter earnings report.

Centene, which jumped into the area’s Obamacare marketplace after Blue KC got out, has profited from its ACA business in other states by selling plans with narrow provider networks, according to Bloomberg.

Medica, which sells Obamacare plans throughout Kansas, took a page out of that playbook this year by transitioning its Johnson County and Wyandotte County plans to an exclusive provider network that covers hospital care only at St. Luke’s Health System and Children’s Mercy Hospital.

Even Blue KC, with its broader network Obamacare plans, had made about $79 million through the first three quarters of 2017 across all of its business, according to Health Plan Week, a newsletter for health care executives.

The nonprofit’s overall medical loss ratio, or amount of premium revenue it put toward paying claims, was about 76 percent. If it stays below 80 percent for the year, the company will have to issue rebate checks to its customers, under Obamacare rules.

Kelly Cannon, a spokeswoman for Blue KC, said the insurer has “seen improved financial results in 2017,” but it lost more than $100 million on its Obamacare products over the previous three years combined. Blue KC wasn’t confident that the recent gains could be sustained given the uncertainty surrounding things like federal payments to insurers, which were recently discontinued.

“This unpredictability created a barrier for our participation in 2018, and we aren’t seeing the changes necessary to create long-term stability,” Cannon said in an emailed statement.

As insurers adjust to the market, a provision in the tax bill passed by Republicans in Congress last week could shake it up again.

The provision repeals the mandate that every American carry health insurance or pay a tax penalty. The individual mandate is intended to keep relatively young and healthy consumers in the market to help offset the cost of insuring older, sicker people.

Trump said ending the mandate essentially fulfilled his promise to repeal Obamacare, because the move will hasten the law’s collapse.

But Larry Levitt, senior vice president of the Kaiser Family Foundation, posted on Twitter Wednesday that it might not be that consequential.

“With strong sign-ups and premium subsidies that increase with premiums, the ACA marketplaces appear to be financially sustainable even without the individual mandate,” Levitt said, while adding that additional fixes may be necessary to help people who don’t qualify for subsidies.

“... There’s no question that the individual mandate promotes market stability. But I have long believed that the carrot (premium subsidies) is more important than the stick (the mandate), if forced to choose just one.”

Andy Marso: 816-234-4055, @andymarso

Children’s Mercy has is in-network for two of the three Obamacare insurers in the Kansas City area. The third insurer, Ambetter, erroneously listed Children’s Mercy practitioners in its online directory earlier in the open enrollment period.