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