Three insurers will offer plans in the North Carolina ACA marketplace
July 10, 2013 5 Comments
It turns out that only three insurance companies will offer plans in the North Carolina ACA marketplace in which individuals can buy subsidized coverage based on their income beginning October 1, with Blue Cross Blue Shield being the only one to offer plans in all 100 North Carolina counties (FirstCarolina will focus on 6 counties, and Coventry on more, but not statewide). The reality of the insurance choices will differ by State–a feature, not a bug of the ACA–but it means that residents in some North Carolina counties will only have one choice of insurance plan, which is much the reality today (BCBS NC is the dominant insurer. In the long run, the number of insurers is a key issue in determining how well a system of individuals buying their own private health insurance with subsidies will work.
This issue is relevant for North Carolina’s nascent Medicaid reform effort as well (link to a series of 5 posts I have written on it) since a key aspect of the plan outline is having “3 or 4 entities” provide the full Medicaid benefit package in all 100 North Carolina counties, thereby providing beneficiaries with a choice. The benefit package provided by the Medicaid program is far broader than is the benefit package that must be covered by plans offered as part of the ACA because of who Medicaid covers (not only acute care, but long term care as well).
For an insurance company to put together a network of providers to deliver the Medicaid benefit package statewide will be 10 times more difficult than pulling together a Medicaid network, because it must include long term nursing home care for persons with dementia, for example, with which no insurance company has any experience bidding (Medicaid now sets the floor price, with some self pay institutions being more).
It is not surprising that North Carolina will not have as much choice as part of the ACA out of the blocks as a State like California, for example, that now has a much more active insurance market than we do. However, the reality that only Blue Cross Blue Shield NC is offering policies statewide underscores how unrealistic is the notion that we will find 3-4 to offer the Medicaid benefit package statewide in some future privatized Medicaid system.