In the turbulence of the pandemic, some of Oregon’s biggest health insurance companies are facing marked drops in membership, while a couple have seen gains, their latest financial filings show.
The membership drops through Sept. 30 appear due in part to steep job losses in the state, and the loss of company health insurance plans for many laid off workers and their families.
A drop in Oregon commercial health insurance rolls is hardly a surprise. Enrollment in the Oregon Health Plan, the government’s insurance plan for low-income people, has surged since the start of the pandemic and now stands at a record 1.22 million, up more than 140,000 since February. At least some of that rise is due to workers losing company-sponsored coverage and seeking out the taxpayer-funded OHP.
The pandemic is hitting Oregon commercial health insurers in various ways, often by eroding their premium income and their membership rolls, the third-quarter filings with the National Association of Insurance Commissioners show. The filings also show that most insurers enjoyed much-reduced expenses for member medical care for the first nine months of this year, in part because providers cut back in-person visits and non-emergency surgeries.
Kaiser Foundation Health Plan of the Northwest’s Oregon membership dropped to 546,000 members as of Sept. 30, from 552,000 members at the end of last year, Kaiser’s filing shows. The decline was in both group and individual memberships.
“We are seeing a drop in commercial members,” said Kaiser Permanente spokesman Michael Foley. He noted: “There is a time lag between losing your job and losing your health insurance. So this trend of declining commercial membership could accelerate.”
In Oregon, the nonprofit Kaiser operates not only health insurance, but also clinics and hospitals. Foley said the Kaiser system is seeing an increase in the number of Oregon Health Plan patients it treats.
Despite the membership drop, Kaiser Foundation Health Plan’s revenues, including premiums, increased to $3.4 billion for the nine months ended Sept. 30, up from $3.2 billion for the same period a year earlier. The plan’s spending on hospital and other medical expenses was roughly flat, and the plan reported a profit of $281 million, up from $135 million for the same period a year ago.
Other big insurers that reported membership drops were Portland-based Providence Health Plan and Tigard-based Health Net. But Portland-based Regence BlueCross BlueShield and Springfield-based PacificSource Health Plans increased membership.
The figures include commercial individual and group members as well as Medicare members. They do not include Oregon Health Plan members, who are handled by the Oregon Health Authority.
The Oregon Division of Financial Regulation, which oversees insurers, doesn’t “fully understand” why enrollment from 2019 to 2020 is fluctuating, said spokesman Brad Hilliard.
A range of factors may be at work, including people moving out of state, people moving on to the Oregon Health Plan, and people being allowed to stay on the Oregon Health Plan when normally the state would have dropped them, forcing them to buy commercial insurance or be covered through their work, Hilliard said. Under federal pandemic emergency legislation, states are temporarily banned from booting people off Medicaid except for very limited reasons, such as moving out of state. Until the government decrees the pandemic is over, states can’t oust people from Medicaid even if their incomes rise above Medicaid limits.
“People who may have (normally) needed to shift to the individual market during the year are not needing to do so,” Hilliard said.
Here’s a look at the latest numbers for Oregon’s biggest commercial health insurers:
Health Net
For-profit Health Net was hit hard by Oregon enrollment declines.
As of Sept. 30, enrollment stood at 40,400 people, down from 59,300 at the end of 2019.
Revenue, consisting mainly of premiums, was $270 million for the nine months ended Sept. 30, sharply off from $370 million for the same period a year earlier. Hospital and other medical expenditures were way down - $230 million versus $342 million for the year-earlier period – yet the company still managed to eke out a profit: $7.7 million for the nine-month period, compared to a loss of $4.2 million for the year-earlier period. Health Net is a subsidiary of Medicaid giant Centene Corp., which also owns Springfield-based Trillium Community Health Plan, a Medicaid insurer in Lane County and the Portland metro area.
Health Net officials did not respond to an email from The Lund Report.
Providence Health Plan
Providence Health Plan, the Oregon commercial health insurance arm of the giant multi-state nonprofit Providence Health and Services, saw enrollment drop to 182,000 as of Sept. 30, from 206,000 at the end of 2019. Providence Health Plan revenues, mainly premiums, took a nosedive, to $854 million for the nine-month period, down from $966 million for the same period in 2019. Medical expenses also sank, to $679 million, from $848 million. The plan was able to record a profit of $46 million for the most recent nine-month period, almost identical to its 2019 same-period bottom line. The membership declines were in both individual and group policies.
Regence BlueCross BlueShield of Oregon
Bucking the downward trend was Regence BlueCross BlueShield of Oregon.
Enrollment as of Sept. 30 stood at 448,000, up from 420,000 at the end of last year. Growth was in group, Medicare, vision and dental enrollment. The nonprofit saw its revenues, mostly from premiums, rise to $1.72 billion for the nine-month period, up from $1.6 billion in the same period a year earlier. Regence kept medical expenses largely flat from last year, making for a bigger profit for this year’s first nine months - $102 million – compared to $62 million for the same period last year.
PacificSource Health Plans
PacificSource Health Plans staked out a small enrollment gain: Enrollment stood at 254,000 on Sept. 30, up from 249,000 at the end of 2019. The nonprofit saw revenues, including premiums, bump up to $734 million for the nine-month period, from $685 million for the same period the year before. Medical expenses were up, too - $603 million compared to $582 million – and the company managed a small profit of $26 million for the most-recent nine-month period, compared to $35 million the previous year. Enrollment gains were in individual and group markets.
Moda Health Plan
Portland-based for-profit Moda Health Plan Inc. had a small enrollment gain, to 102,000 as of Sept. 30, versus 97,000 at the end of 2019. The company’s overall financial results were distorted by a one-time gain of $249 million, a settlement paid by the federal government for failing previously to pay health reimbursements to Moda. Separate from the settlement, Moda had premium revenues of $489 million for the nine months ended Sept. 30, up slightly from $477 million for the same period a year earlier. Medical expenses were marginally down, to $433 million, from $445 million. Including the settlement, Moda had a profit for the nine months of $251 million, up from the previous year’s $36 million.
Samaritan Health Plan
Corvallis-based Samaritan Health Plan, part of nonprofit Samaritan Health Systems, saw its membership decline to 8,800, from 9,900 at the end of 2019. The plan’s revenues for the first nine months were largely flat compared to the year earlier period, at $74 million. Medical expenses were down, at $56 million, compared to $63 million, leaving a profit for the first nine months of $6.5 million, compared to $1 million for the year-earlier period.
You can reach Christian Wihtol at [email protected].
