Blue Cross requests 23 percent rate increase for ACA customers in NC

DURHAM, N.C. (WNCN/AP) – Blue Cross and Blue Shield of North Carolina has requested a 22.9 percent average rate increase in 2018 for customers who enroll in the Affordable Care Act, the insurer said Thursday.

Blue Cross said the increase in medical costs, the Federal Health Insurance tax and cost-sharing reduction funding are the factors behind the request to the North Carolina Department of Insurance.

The majority of the requested increase came from the lack of funding for CSR payments, Blue Cross said.

“We’re seeing the market begin to stabilize after three years of coverage,” said Brian Tajlili, director of actuarial and pricing services for Blue Cross North Carolina. “Unfortunately, the lack of CSR funding significantly increases the rates for all ACA customers.”

The CSR subsidies help lower-income ACA customers purchase special plans with lower out-of-pocket costs for medical care, Blue Cross said in a release.

“The simplest thing to do would be for the Trump administration and Congress to pay the Blue Cross Blue Shield and many other insurance companies the money that they’re owed,” said Brendan Riley, health policy analyst at the North Carolina Justice.

That sentiment was echoed when CBS North Carolina asked Blue Cross Blue Shield of North Carolina’s manager of public relations, April Umminger, what the company would say to patients who feel the hike would be too much of a financial burden.

“We understand health insurance coverage is already a large portion of our customer’s household income and with the proposed rate increase many customers will pay more for coverage,” she said in a statement.


“It is for this reason that any health care reform must address the underlying cost of care and not just access, and in the immediate, funding for 2018 CSR payments needs to be appropriated so that the increase necessary for next year can be greatly lessened.

Blue Cross said with the CSR payments, the requested rate increase would have been 8.8 percent compared to 22.9 percent.

CBS North Carolina’s Justin Quesinberry asked Riley if even that rate would still hurt customers.

“Fortunately in North Carolina, more than 90 percent of people who enrolled in the marketplace qualify for a tax credit that shields them from any premium increases,” he said.

“I don’t think we fault them (Blue Cross) for requesting higher premiums,” Riley said about Blue Cross Blue Shield’s proposed rate hike.

As for Blue Cross’ reasoning that part of the hike is due to increase in medical costs, including physicians services and prescription drugs, CBS North Carolina’s medical expert, cardiologist Dr. Kevin Campbell, said doctors are being “reimbursed at an all time low rate right now.”

CBS North Carolina’s Justin Quesinberry asked Dr. Campbell what patients and doctors can do about rate hikes.

“I think that as a doctor and as a healthcare consumer and as a patient, we have to do our very best to partner with one another and work together within the system, albeit flawed,” he said.
“Express your concerns to your representative in Congress or your senator.”

The rate hike is a proposal.

The North Carolina Department of Insurance must review the filing and ultimately approve or deny the hike. The department runs numbers “to make sure the health insurance rates submitted, according to NC insurance laws, must not be excessive, inadequate, or unfairly discriminatory, and must exhibit reasonable relationship to the benefits provided in the policy,” a department spokesman said.

That review process takes about 90 days.

Thursday’s announcement comes a day after Blue Cross and Blue Shield of Kansas City said it will leave the individual market next year, a decision that affects about 67,000 people in a 32-county area in Kansas and Missouri.

Other insurers, such as Aetna and Humana, have also said they will abandon this kind of coverage, though some, including Centene say they will stick around.

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