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Highmark unsure how to implement ACA changes

CHARLESTON, W.Va. -- Highmark officials say they are not sure how the recently announced changes to the Affordable Care Act will be implemented.

President Obama on Thursday said insurance companies may continue to offer health plans that otherwise would have been canceled as the ACA was rolled out. This change to the federal law is only in effect for about a year, through Dec. 31, 2014.

"It is unclear how these proposed changes can be put into effect," Highmark said in a statement released Thursday evening. "Many of the details of the federal proposals to change the Affordable Care Act are still in development, including the operational and financial implications to insurance companies."

Highmark Blue Cross Blue Shield is the state's largest insurance company -- and the only one to offer plans on the state's Health Insurance Marketplace.

The federal health-care law requires that insurance plans offer a specific set of essential benefits, including emergency care, mental health and maternity care. If they don't, the plans can be "grandfathered" in, as long as they have existed continuously since before the law was enacted and have had no changes.

Those insurance plans that have changed since the law was enacted are not allowed under the new law and eventually will be canceled.

According to Highmark, 8,300 individual-policy holders in West Virginia would have had their plans canceled by January because of the ACA -- and they still will be affected after Dec. 31, 2014.

Highmark already had planned to give its individual-policy holders the option to renew their policies in December, thereby extending the coverage they have until December 2014. Those affected also can enroll in a new insurance plan on the exchange, but problems with the federal website, healthcare.gov, are making that challenging, Highmark said.

"Certain consumers whose policies are being discontinued would qualify for federal subsidies and would need to obtain coverage through the federal exchanges if they intend to secure financial assistance," the company said in its statement. "However, other consumers with discontinued policies are not likely to qualify for subsidies and can immediately secure the very same quality, health care coverage at the same rates as our products on the federal exchange by coming directly to Highmark West Virginia to enroll.

"In many cases, the options available to these consumers are better coverage at better prices than what they have currently," according to Highmark.

Highmark called on the federal government to ensure a stable health insurance market and to not allow health-care costs to escalate because of the federal exchange's challenges.

"We will work with the federal and state governments, in particular the Offices of the West Virginia Insurance Commissioner, to better understand and execute on this as the details are known," Highmark's statement said.

Obama had been under pressure to adjust the law because he initially had said those people who like their existing plans would not have to purchase a new one on the health insurance exchange.

"If you like your plan, you can keep it, period," Obama had said. That was not true, however, for individual-policy holders. About 3.5 million Americans have received cancellation notices, so far, according to The Associated Press.

Perry Bryant, executive director of West Virginians for Affordable Care, said some of the insurance plans that would have been canceled nationwide by January have been affordable and sustainable in the past because insurance companies were able to keep sick people out of the market.

"Some of them were basically being subsidized by [insurance companies] not covering people with health problems," he said. "By doing away with pre-existing conditions and not allowing companies to discriminate, you can't make everyone a winner moving to that type of system."

Reach Lori Kersey at lori.kersey@wvgazette.com or 304-348-1240.


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