Texas metro areas to see premium spikes, fewer providers (AP)

Large population hubs in Texas will see the sharp increases in health premiums under the Affordable Care Act that federal officials announced earlier this week, but the sting won’t be felt as deeply in some more rural settings, an analysis for The Associated Press shows.

Meanwhile, Oklahoma is among five states that will have only one participating health insurer in 2017.

Premiums for a midlevel benchmark health plan will increase an average of 25 percent across the 39 states served by the federally run online market, which include Texas and Oklahoma, according to a report from the Department of Health and Human Services. About 1 in 5 consumers will have plans only from a single insurer to pick from, after major national carriers such as UnitedHealth Group, Humana and Aetna scaled back their roles.

A county-by-county analysis by AP and Avalere Health shows premiums in Austin, Dallas and Houston continue to rise as insurance providers pull out, leaving fewer options for those not covered under an employer’s plan. It’s not clear that insurers bailing out is the main reason driving double-digit increases across many parts of the country.

In Dallas County, the premium for a midlevel plan was about $300 in 2015 but rose to $369 this year and will rise to $395 next year. Seven different insurers served the county last year, but there will be just two in 2017.

Premiums for the same plan in Travis County jumped 66 percent this year and will go up an additional 15 percent for the new year. People in the Austin area who signed up for the federal exchange had nine insurance providers to choose from in 2015 but that number now will drop to three.

“With fewer health plan options and higher monthly premiums, it’s likely that some individuals and families insured through the marketplace will not re-enroll in health insurance coverage next year,” said Lisa Kirsch, senior policy director at the University of Texas’ Dell Medical School. “It will take time to measure the full extent of change in insurance enrollment and the impact on Texans’ health.”

The number of Texans enrolled in the federal exchange stands at more than 1.3 million, up from about 1.2 million a year ago. Texas is the federal health care exchange’s third-largest market, after Florida and California. Sign-up for the 2017 enrollment season starts Nov. 1.

Insurers say they’re confronted with new customers who turned out to be sicker than expected, and not enough younger, healthier people signing up to help defray costs. Also, the federal law’s internal system to help balance out gains and losses among insurers has not worked well.

Blue Cross Blue Shield has about 603,000 individual policyholders in Texas and offers coverage in every county. The company is seeking increases averaging from 57.3 percent to 59.4 percent across many of its individual market plans. But 177 counties in Texas — primarily rural ones that in many cases are served by just one provider — will see a premium drop of 16 percent.

In Oklahoma, the reduction to a single insurer — Blue Cross Blue Shield of Oklahoma — should have minimal impact, as roughly 85 percent of residents who purchase coverage on the exchange are eligible for subsidies that greatly reduce premium costs, health care advocates said Thursday.

“Certainly, the goal is to have more insurance companies participate, and the hope is, after the election, there are some tweaks that can be made to the Affordable Care Act that would help encourage more plans to participate,” said David Blatt, the executive director of the nonprofit Oklahoma Policy Institute. “But again, for the 85 percent of Oklahomans (who have purchased coverage), it’s not going to have much of an effect.”

Some providers have been forced to pull out of Oklahoma because of its refusal to accept federal dollars to expand its Medicaid program, said Laura Dempsey, vice president of community advancement at Morton Comprehensive Health Services Inc., the largest community health system in northeast Oklahoma. If the state were to accept the federal expansion, roughly 175,000 residents would become insured, she said.

Texas also has declined to expand its Medicaid program.

President Barack Obama’s administration estimates that 72 percent of HealthCare.gov customers will still be able to find a plan for less than $75 a month after taking into account subsidies.

Cynthia Cox, who conducts economic and policy research on the Affordable Care Act for the Kaiser Family Foundation, said the spike in premiums is not surprising, in part because it was anticipated that many insurers priced their plans too low in some markets. If consumers respond to premium hikes by dropping out, then the federal health plan will be further shaken, she said.

“But if we see enrollment hold steady or increase, as it’s expected to, that would be a sign of stability,” she said.