It’s always hard to know when an insurer such as Blue Cross and Blue Shield of North Carolina seeks a huge rate increase what the final number will be. Regulators need to assess how much of the request is a sound need to ensure the company’s economic health and how much of it is the company putting a high number out, knowing it will be knocked down by federal and state regulatory review.
Blue Cross and Blue Shield, the state’s largest health insurer, said Monday it is seeking an average 25.7 percent rate hike for its customers who are covered under the Affordable Care Act. The federal law has made health insurance available to people who otherwise might not be able to afford it, or who have medical conditions that would eliminate them from consideration for coverage. The ACA has made health insurance a reality for millions of Americans, most of whom are getting subsidies that make the insurance affordable, or at least more so.
In North Carolina, nearly 500,000 people have found health insurance through federal exchanges under the ACA. That’s all the more remarkable given that state Republicans declined to participate in setting up an exchange to help people get insurance, and so North Carolinians had to go through a federally run exchange. The failure on the part of the GOP leaders in the General Assembly represented a repudiation of hundreds of thousands of people they’re supposed to serve.
But the state’s residents found ACA help anyway. And to its credit, Blue Cross and Blue Shield helped guide them through the process of getting insurance. There’s something in it for BCBS, of course: more customers.
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But now the company says it needs a rate hike to cover expenses that come with paying more claims from people who have medical conditions that are expensive to treat. And, yes, given the reach of BCBS in North Carolina, it’s important that the company remain financially stable and able to cover the medical costs of its customers, including those under the ACA.
The office of the state Commissioner of Insurance, however, will have a role in determining how big a rate increase BCBS will get, and it’s likely to be less than the company wants. The company does note that the rate increases will vary depending upon customers’ ages, locations and health habits.
But the commissioner, Wayne Goodwin, must be cautious and conservative in approving a hike. The process is further complicated by uncertainty. With a U.S. Supreme Court ruling on the ACA coming, North Carolinians with insurance under the ACA may face a bigger risk than rate hikes.
The high court is going to rule on one part of the ACA involving the subsidies paid to those who qualify. At issue is whether those people in states that did not create their own health care exchanges are going to be eligible for federal subsidies. If the court should rule that they are not, hundreds of thousands of people in this state, and millions all total, would be at risk of losing their health insurance.
The painful irony in all this is that, as has been reported in recent weeks, Republicans in Congress haven’t focused much lately on the Affordable Care Act, which they long vowed to kill. That’s likely because millions of people are now covered and happy with their coverage, and also because the consequences Republicans forecast during the ACA debate – explosive growth in the federal deficit, skyrocketing health care costs – haven’t come to pass.
Still, because of the shortsightedness of their elected Republican leaders, North Carolinians with health insurance under the ACA now have double the worry, of higher premiums and the potential loss of the subsidies that make it possible for them to be covered at all. So they must hope that the high court will support the subsidies as they exist and that their insurance commissioner will give close scrutiny to health insurance rate hike requests.