Enrollment Surges by Private Health Plans During Second Quarter

Carriers recovered their financial losses, with the exception of LifeWise. Note: HealthNet's quarterly profit was $9.9 million; an earlier version of this story incorrectly reported a loss for the insurer.

More than 14,000 Oregonians lost their employer-based health insurance in the second quarter of 2014, while many times that number signed up for new individual health plans over that period, according to financial reports filed with insurance industry regulators and obtained by The Lund Report this week.

The state’s insurance companies reported a surge in the number of people covered by private health plans since the start of the year, when the Affordable Care Act began to mandate individual coverage. From January through March, 21,925 people obtained private comprehensive insurance (as opposed to enrolling in a Medicaid-funded coordinated care organization or a Medicare plan). And from April through June, another 28,486 got private comprehensive coverage.

But all of this growth has been in individual plans, which consumers buy directly, rather than in employer-based health coverage, which for decades has been the primary route to healthcare for hundreds of thousands of people in the state.

Since Jan. 1, 83,362 people have enrolled in private comprehensive health insurance, bringing the total number of Oregonians enrolled in these plans to 260,832. Insurers noted that many of these new plans were partially subsided through health insurance exchanges, but a break-down of how many were purchased at full-price and how many were subsidized is not available.

Meanwhile, since the start of the year employers have dropped 32,958 people from these health plans. Some companies may have moved to self-insured programs, which are not reported to regulators. Big job centers like Nike, Intel and the state of Oregon have long been self-insured, which generally means they pay traditional insurance companies to administer claims and negotiate rates with doctors, but these employers pay medical costs directly rather than buying traditional insurance plans.

And even with a drop, employers are still the main source of health insurance in Oregon, covering 872,723 lives.

But the numbers appear to show a dramatic recent shift – and a closer look shows that this broad trend is boosting market share at some insurance companies, while others lose ground.

Moda Health Plan enrolled more new members in the second quarter than any other Oregon health insurance company, and 91 percent of its new policies were individual health plans, making it the second-largest issuer of comprehensive health plans in the state, behind Kaiser Permanente. (Regence BlueCross BlueShield covers considerably more people than Moda overall, but only when vision, dental Medicare, Medicaid and other non-comprehensive-types of health insurance are included.)

Here’s how the state’s insurers ranked, by number of comprehensive health insurance plans issued:

  1. Kaiser Permanente: 373,509 members in comprehensive plans (93.8 percent employer-based).

  2. Moda Health Plan: 197,146 members (31.5 percent employer-based).

  3. Regence BlueCross BlueShield of Oregon: 178,305 members (81.6 percent employer-based).

  4. Providence Health Plan: 140,400 members (90.9 percent employer-based).

  5. PacificSource Health Plans: 138,555 (80.6 percent employer-based).

  6. Health Net Health Plan of Oregon: 53,316 members (92.6 percent employer-based).

  7. Lifewise Health Plan of Oregon: 39,247 members (58 percent employer-based).

As they navigate the shift in how Oregonians are obtaining insurance, these companies – most of which are incorporated as nonprofits – are also learning how to remain profitable.  In the first quarter of 2014, as the Affordable Care Act’s new mandate went into effect amid concerns about the failed Cover Oregon health exchange website, five out of seven major insurers reported net losses. By the second quarter, five out of seven were profitable – only LifeWise reported losses.

LifeWise was able to easily absorb its $1.2 million second-quarter net loss. HealthNet has decided to not participate in the health insurance exchange next year.

Including all forms of health insurance – not just comprehensive plans – here’s how the state’s seven major domestic insurers ended the second quarter:

  1. Regence BlueCross BlueShield of Oregon: 470,020.

  2. Kaiser Permanente: 468,070.

  3. Moda Health Plan: 198,964.

  4. Providence Health Plan: 186,614.

  5. PacificSource Health plans: 177,616.

  6. Health Net Health Plan of Oregon: 70,425.

  7. LifeWise Health Plan: 47,201.

See the attached spreadsheet for a breakdown of the types of coverage these companies provide.

Courtney Sherwood can be reached at [email protected]. Follow her on Twitter at @csherwood.

Correction: Health Net Health Plan of Oregon reported a $9.9 million net profit in the second quarter of 2014. An earlier version of this story incorrectly reported a net loss, due to an error in calculations.

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