With Enrollment a Week Away, Some Details about Affordable Care Act Remain Muddled; PRICING PUZZLE; Federal Estimates Show Missouri in the Middle of the Pack on Rates.; LIMITED CHOICES; Providers Such as BJC Healthcare May Be Excluded from Plans

Article excerpt

New health insurance marketplaces are fostering competition that will mean lower premiums than initially expected, federal officials said Tuesday.

In a new report, the U.S. Department of Health & Human Services provided estimates of average policy rates for consumers in 36 states, including Missouri and Illinois, where the federal government is involved in setting up the marketplaces.

According to the report, about 95 percent of non-elderly consumers will have a choice of two or more health insurance issuers. And in most states, rates will be significantly lower than earlier estimates by the Congressional Budget Office.

The latest findings, HHS Secretary Kathleen Sebelius said in a telephone news conference, show the Affordable Care Act is helping families and individuals nationwide "make health insurance work within their budgets. ... Now, there will be more choice and more competition, thanks to the marketplace."

But the report was short on key details, which won't become available until the marketplaces begin open enrollment on Oct. 1. Federal officials did not identify the insurance companies that are participating in the marketplaces nor describe the breadth of their health provider networks.

Area health insurance experts say only a few insurers may end up participating in Missouri's health marketplace, resulting in less competition and higher prices. And they also have voiced concern that insurers to hold down premium costs may limit their policies to "narrow networks" of hospitals and physicians.

According to St. Louis-area health brokers and consultants, BJC Healthcare Missouri's largest health provider is likely to be excluded from most policies sold on the marketplaces because of BJC's high medical charges.

Anthem Blue Cross and Blue Shield in Missouri, which has dominated the state's individual health insurance market, has decided to operate a narrow network both on and off the health insurance exchange that would exclude BJC facilities and physicians, said Paul Flotken, managing partner of Caravus, a St. Louis-based health benefits consulting firm.

Flotken and two local health insurance brokers also said Anthem appeared to be still deciding earlier this week whether to include Chesterfield-based Mercy Health hospitals and physicians for individual policies sold on the Missouri exchange.

If Anthem excludes BJC Healthcare, it would be a blow to consumers and also may prove a setback for BJC, the St. Louis area's largest employer.

While not addressing Anthem's apparent plans during Tuesday's news conference, HHS Deputy Administrator Gary Cohen said: "The use of narrower networks is something that people have talked about for a long time. It's a positive development to keep health care costs down."

FEDERAL ASSURANCES

The HHS new report summarizes what the average premiums will look like state by state in the insurance marketplace.

According to the report:

* Individuals have on average 53 plan choices in the 36 states with federal involvement, and premiums before tax credits will be lower than expected by more than 16 percent. Missourians will have access to 17 plan choices.

* After including tax credits, 56 percent of uninsured Americans may qualify for coverage in the exchange for less than $100 per month.

* Missouri's rates fall somewhat in the middle of states' varied premiums. St. Louis city and metro rates are identical but slightly cheaper than the state average. For example, a Missouri family of four with a household income of $50,000 can buy bronze coverage, a plan that offers the least benefits, for $72 a month after tax credits are applied. A 27-year-old Missouri resident who makes $25,000 a year can get bronze coverage for $87 a month.

ANTHEM'S NETWORK

Flotken said Anthem's representatives had indicated in recent meetings that a narrow network would be the only choice available both on and off the Missouri exchange for Anthem's individual health insurance products. …