State Regulators Persuade Moda to Sell Exchange Plans in Lane County

The Eugene area and Tillamook County will now have a choice between Providence and Moda on healthcare.gov, after Moda Health initially declined to sell plans on the exchange. Most consumers will have three or more options in Oregon in 2018, but not most counties, as rural areas will typically have just two choices. Douglas and Lincoln counties will have only Providence.

Eugene consumers will have more than one option on the healthcare.gov online marketplace next year after all, after state regulators were successful in persuading Moda Health to sell plans in Lane County next year, as well as Tillamook County on the Coast.

“We are pleased that Moda Health Plan has agreed to offer coverage in Lane and Tillamook counties, ensuring that those who live in those communities will have a choice between at least two on-Marketplace companies in 2018,” said Jake Sunderland, public information officer for the state Department of Consumer & Business Services.

Sunderland said regulators asked Moda and other insurers to expand geographic coverage so that there might be competition in the market for rural areas and the state’s second-largest city, but he said they gave Moda no special favors.

Last year, the Division of Financial Regulation approved additional rate increases for Providence Health Plan and Regence BlueCross BlueShield to help them move back into areas that they wished to retreat.

Consumers in two other rural counties -- Douglas County and Lincoln County -- will have to purchase insurance from Providence Health Plan -- the only statewide carrier remaining on the exchange -- if they wish to seek subsidized coverage, although Health Net Health Plan will also be offered statewide for consumers paying the full cost outside the exchange.

About 63 percent of Oregonians will have the option of three or more insurers, but most counties will have just two options on the exchange as only Providence and Moda are willing to sell plans in most of rural Oregon.

“We remain concerned about the limited health plan choices some counties are facing, and will work with insurance companies throughout the next year to try to increase competition throughout the state in 2019,” Sunderland said.

Douglas County had been served by local insurer Atrio Health Plans, but that company has pulled out of the commercial health insurance market completely, citing the volatility of the market and the cloud that Trumpcare cast upon their ability to do business:

“Our decision to make this announcement and refocus the organization on our core competency was driven by the uncertainty and instability of the ACA/ACHA and the inability to obtain favorable facility contracts for our commercial business in certain geographic markets,” said Samuel Porter, the interim chief executive officer at Atrio, in June.

Porter said that Atrio will continue to sell Medicare Advantage plans to senior citizens in Douglas County, as well as Salem and other parts of southern Oregon.

The online marketplace will be down to five health insurers in 2018, but only consumers in the tri-county Portland metro area will be offered all five. Even in the state’s most competitive market, insurance broker Rick Skayhan of Leonard Adams Insurance said competition may be an illusion on the individual market, since health systems are increasingly tied to their favored insurers.

“Each of the carriers is aligned with a hospital system; each has their own network -- how much competition does it really have?” he said.

Skayhan said Regence was dropping Legacy Health next year, forcing individual market consumers who want Legacy physicians and services to pick Health Net or PacificSource.

An unsubsidized PacificSource premium will cost on average nearly $1,500 a year more than a similar Kaiser Permanente plan, and the company is not likely to be a serious player on the individual market next year as a result. For consumers who don’t want or can’t get Kaiser insurance, Providence will be the second-most affordable, at an unsubsidized average of $414 a month compared to Kaiser at $348 a month.

Kaiser will offer insurance in 10 counties, including all of the Willamette Valley except the Eugene area. The health system opened clinics in Lane County in 2016.

Aside from the metro counties, PacificSource will also sell plans in central Oregon. Moda will sell plans in all but four counties, declining to sell in Linn and Benton as well as Lincoln and Douglas.

“Having only two options still isn’t great, but any level of choice and competition is better than none,” said Jesse O’Brien, the health advocate for the Oregon State Public Interest Research Group, which closely monitors the state’s health insurance markets.

The insurance commissioner raised the rates of individual market health plans by an average of 5.3 percent from 2017 to 2018 when measured by plan and 9.2 percent when measured by enrollment. State officials said a pending state reinsurance program prevented another year of double-digit increases but said that the Trump administration’s scaled-back enforcement efforts of the individual mandate raised premiums 2.4 to 5.1 percent by decreasing the number of healthy people in the risk pool.

Reach Chris Gray at chris@thelundreport.org.

Correction: The percentage increases were corrected and clarified for the individual market rates.

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