RICHMOND, Va. (WAVY) — The industry group that represents Anthem Blue Cross Blue Shield points to “sicker clients” and lower federal subsidies as the reasons Anthem discontinued individual policies in certain areas of the commonwealth.
Until late last year, the premium with Anthem for Thomas Ema and his wife Liz of Williamsburg was $1,600. Then Anthem stopped writing individual policies like theirs, and they had to go with Optima.
“We can’t shop for it, we can’t compare prices, we only have one option,” she said. Instead of $1,600 their premium is now $2,800 per month for less coverage.
“We have higher deductibles, higher co-pays, less pharmacy.”
And it’s not as though Thomas can do without his various medicines and trips to the doctor. He has several conditions, including the need for monthly injections that would run $8,000 each if he had to pay out of pocket.
We asked Anthem why it dropped the Emas, and Anthem referred us to its industry group in Richmond. It turns out it was a business decision related to Obamacare.
“The population that’s being covered is much sicker than predicted,” said Doug Gray, Executive Director of the Virginia Association of Health Plans. “As a result, the plans have lost money in the last three years participating in that market.”
Gray says insurers are having to cover their clients’ health care without two key parts of Obamacare — re-insurance and cost-sharing reductions. He estimates those two federal subsidies accounted for as much as 37 percent of premiums.
“So it would be an enormous help if Congress would do it, but at this point the administration is not paying CSRs intentionally.”
In the meantime, Gray says his member companies have to make up the shortfall from people like the Emas, who don’t qualify for payment assistance.
Gray says legislation has been proposed on Capitol Hill in both the House and Senate, but it has no momentum because the debate is stalled and Obamacare is unpopular with the Republican majority.Thomas Ema says he hopes that Governor Northam, with his medical background, might have some input for the debate over controlling the cost of health care.