Blue Cross parent lost $1.5 billion on individual health plans last year

Year 2 of the Affordable Care Act was another financial flop for the Chicago-based parent of Blue Cross and Blue Shield of Illinois but hints of a turnaround are emerging.
Health Care Service Corp.'s financial losses in its individual business, which includes ACA plans, worsened in 2015. The company, which owns Blue Cross affiliates in Illinois and four other states, said it lost $1.5 billion in its individual business, up from $767 million in 2014, the first year of the health law's state exchanges for buying coverage.
In anticipation of ACA-related losses in 2015, HCSC set aside nearly $400 million in 2014 to boost reserves to $680.9 million. The company spent $657.3 million of those reserves to cover the medical expenses associated with ACA plans in 2015.
HCSC is the latest large insurer to report losses on 2015 ACA business, a troubling sign for the state exchanges that are the heart of President Barack Obama's health care overhaul. The far-reaching legislation has increased access to insurance coverage by expanding Medicaid and providing tax credits to subsidize the cost of insurance. Though the law has brought new customers to many insurers, much of that growth has been unprofitable, reflecting higher-than-expected medical expenses, regulatory challenges and unexpected shortfalls in federal risk-sharing programs.
UnitedHealthcare said it had losses of about $475 million on its 2015 ACA business. Aetna didn't break out the loss on its individual health plans but said the operating losses on that line of business were 3 to 4 percent of the sales. 
As a result of the losses, some insurers have considered withdrawing from the state marketplaces. Any exodus would threaten the stability of exchanges, making the online marketplaces less attractive to consumers.
"2015 was not a good year as far as the ACA went," said Stephen Zaharuk, senior vice president at Moody's Investors Service, who covers the health insurance industry. "Insurers had no idea what to expect."
Still, no one expected the rollout of some of the biggest reforms in health care to be smooth. The exchanges are a new way to sell health plans to a population that largely was uninsured. Moreover, the law forbids insurers from using consumers' medical history to set prices. Insurers were essentially groping in the dark.
But with two years of experience under their belts, insurers may be on more secure footing. HCSC, for one, didn't book a reserve for potential 2016 losses on ACA plans, said Carl McDonald, a divisional senior vice president at the company. Zaharuk said that's a good sign the company's individual business may break even this year.
But HCSC officials are not so optimistic that the ACA plans will be profitable in 2016. Company spokesman Greg Thompson said in an email, "Our not booking a (reserve for ACA losses) for 2016 does not indicate nor imply an anticipated level of profitability for the year."
Despite problems with its ACA-related business, HCSC narrowed its overall loss in 2015, according to a financial statement filed with the National Association of Insurance Commissioners. The filing is primarily an accounting of its fully insured lines of business.
The company reported a loss of $65.8 million, down from $281.9 million in 2014, reflecting higher earnings from its group health plans and an increase in investment income. Premium revenue rose 12.5 percent to $31.2 billion.
HCSC is among the biggest players in the individual market, with 1.64 million members at the end of last year, an increase of 3.4 percent, according to the filing. Nearly one-third of its enrollment is in Illinois, where Blue Cross sold roughly 80 percent of all 2015 individual policies in the state.
HCSC doesn't disclose how much of its individual enrollment came from ACA plans sold on and off the exchanges. The individual market also includes policyholders who were allowed to keep the plans they had before the health law was implemented through 2017. Insurers blame that last-minute change by the Obama administration for keeping healthier people out of the exchanges.
When the exchanges launched, HCSC's Blue Cross plans offered some of the lowest-priced policies and largest provider networks. The strategy was to provide cost-effective health care access, reflecting the company's status as a not-for-profit, customer-owned insurer, analysts said.
However, medical costs and customers' use of health care services on ACA-related plans were higher than anticipated. In 2014, HCSC's key medical-loss ratio, which measures the share of premiums used to pay patient medical costs, rose to 86.5 percent, from 85 percent. Last year, the ratio jumped to 90.4 percent, according to the annual statement.
To manage the risk, HCSC followed in the footsteps of its for-profit competitors and made significant changes last year that were not consumer friendly.
The company raised 2016 premiums and redesigned policies to shift more costs to consumers. In Illinois and Texas, its two largest markets, HCSC eliminated its popular PPO plans that were more expensive but had the largest networks of hospitals and doctors. The decision sent Blue Cross customers scrambling to find other plans on the exchanges that included their doctors.
The company even took the hard line of walking away from business. In New Mexico, the company sought a rate increase averaging 51.6 percent, after it said it lost $19.2 million in 2014 on its individual business in the state. New Mexico insurance regulators rejected the request but were willing to approve a lower increase, according to published reports. Instead, HCSC pulled out of the New Mexico exchange.
The company also is cutting expenses. Thompson confirmed that HCSC has laid off employees in its information-technology department but declined to say how many were let go. Last month, the company eliminated commissions to independent brokers in Illinois, Texas and Oklahoma on sales of individual plans that take effect April 1 or later.
After eliminating commissions in Illinois, Blue Cross said it remains committed to "expanding access to quality health care to as many people as possible." The changes are necessary to continue offering "sustainable" health plan options to members, the company said.
Despite signs of strain, the Obama administration says the exchanges are getting stronger. There were many new customers among the 12.7 million people who chose plans during open enrollment for 2016. In Illinois, enrollment grew nearly 12 percent to about 388,000.

Still, the administration has tweaked some regulations to benefit insurers. It placed a one-year moratorium for 2017 on the annual tax insurers pay, which is generally passed along to customers. The change will save some insurers hundreds of millions of dollars. For 2016, HCSC expects to pay a fee of $538.7 million.
The administration also has tightened some of the eligibility rules for people who sign up for insurance after the enrollment deadlines. Insurers have complained that people are waiting until they are sick to buy plans and then dropping coverage after their health problems are resolved, driving up costs and premiums.
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