Blue Cross and Blue Shield of North Carolina and the Affordable Care Act in North Carolina have had a rough couple of weeks.
The troubles began with a balky new software system at Blue Cross that scrambled enrollments and issuance of insurance cards for people covered by individual policies. At the peak of the confusion, Blue Cross said it received 147,000 in one day. Meanwhile, state Insurance Commissioner Wayne Goodwin is responding with a rare “deep dive” audit to determine the cause of the insurer’s ongoing technology problems.
Into this frustrated context came news that Blue Cross has lost more that $400 million on its ACA business in the first two years of the health care law and is considering getting out of the individual insurance market altogether. Goodwin added to the concern by sending a letter to Sylvia Burwell, secretary of the U.S. Department of Health and Human Services, saying the “burdens of the ACA” were driving insurers out of North Carolina’s individual insurance market.
Given the converging headlines, it’s understandable that some may think the ACA is causing chaos in the state’s insurance industry. However, the Blue Cross technology glitch and its ACA losses are distinctly separate situations. Blue Cross is fixing the software problem, and Goodwin’s audit will look closely at its causes. It is a passing event.
The ACA losses are a much larger issue. The losses threaten what has been an exceptionally popular option for people without insurance. North Carolina has the third-highest ACA enrollment in the nation.
But to keep working, the Affordable Care Act will have to be affordable for insurance companies. Toward that end, Goodwin has approved a 32 percent average rate hike on Blue Cross’ ACA policies. And the federal government is tightening enrollment policies to keep people from signing up just before they incur major medical expenses.
The ACA needs such adjustments, but it’s also being undermined by Republican opposition. The GOP-led General Assembly refused to set up a state-run exchange, thus stripping the insurance commissioner of his leverage on premiums or his ability to adjust to suit the state market. And the legislature refused to expand Medicaid, leading some low-income people whose medical costs could have been borne by the government to instead be enrolled in a Blue Cross or other private ACA plan.
Goodwin, a strong supporter of the ACA, is frustrated that the legislature’s intransigence has left him largely powerless to attract more insurers to sell ACA policies here, to educate consumers about how to use their new insurance most efficiently and to give a fuller review to rate hike requests. Now he’s appealing to federal authorities to provide waivers so he has more room to operate within the federal exchange.
Adopting a new national program to make health insurance affordable to all was never going to be easy, but unrelenting Republican opposition in the legislature and in Congress has made it much harder.