Despite the hikes, the ACA still works

Blue Cross Blue Shield of North Carolina Triangle Sales Center in the Village Market Place shopping center in Morrisville.
Blue Cross Blue Shield of North Carolina Triangle Sales Center in the Village Market Place shopping center in Morrisville. hlynch@newsobserver.com

It was, at least, no surprise. Blue Cross and Blue Shield of North Carolina, the only company that offers health care policies in all 100 counties in the state, has announced an average 24.3 percent cost increase for premiums on policies under the individual plans through the Affordable Care Act.

Not all customers will pay more, and 90 percent of those insured under the ACA already, through federal exchanges, will continue to get subsidies which will make their premiums affordable. A 32 percent hike went into effect this year.

BCBS has felt big losses from its ACA business, and two companies, UnitedHealthcare and Aetna, have pulled out of ACA coverage. Only one other company, Cigna, is planning to offer coverage in North Carolina, in five counties in the Raleigh area.

BCBS acknowledges that those paying the full premiums with a subsidy are taking a hit. The new rates won’t affect most of the company’s 3.9 million customers covered under state employee plans, the state health plan and other policies.

Cynthia Cox of the Kaiser Family Foundation said the increases here and elsewhere may show that the first plans offered under the ACA were priced too low. She also said that premiums were below what the Congressional Budget Office had projected they would be in 2009.

BCBS also has the problem of the other companies’ withdrawal to deal with. The customers of those companies, some 260,000 of them, will now have to come to Blue Cross, and a good many of those customers may have significant and costly medical issues to deal with. That’s no small challenge for BCBS or any other insurance company.

This is one aspect of the ACA — which required most people to get insurance or pay a penalty — that is an ongoing problem. Without younger, healthier customers enrolled, customers who don’t need to make claims, insurance companies are crunched by increasing claims from older, sicker customers. Not enough of those younger people are signing up.

And unfortunately, given the partisan divide in Congress, it’s virtually impossible to “tweak” the ACA — to prevent companies from pulling out of a market, to strengthen the requirements for everyone to have health insurance, to bolster subsidies — because Republicans in Congress just want to kill the program outright.

The next president, and the next Congress, must find the solution, and with nearly 20 million people insured under the ACA, people who would be without insurance if Congress repealed the program, that solution must not be delayed.