UnitedHealth to trim ACA exchanges to 'handful' of states

Posted April 19

UnitedHealth, the nation's biggest health insurer, will cut its participation in public health insurance exchanges to only a handful of states next year after expanding to nearly three dozen for this year.

CEO Stephen Hemsley said Tuesday that the company expects losses from its exchange business to total more than $1 billion for this year and last. He added that the company cannot continue to broadly serve the market created by the Affordable Care Act's coverage expansion due partly to the higher risk that comes with its customers.

The state-based exchanges are a key element behind the Affordable Care Act's push to expand insurance coverage. But insurers have struggled with higher than expected claims from that business.

UnitedHealth Group Inc. said it now expects to lose $650 million this year on its exchange business, up from its previous projection for $525 million. The insurer lost $475 million in 2015, a spokesman said.

UnitedHealth has already decided to pull out of Arkansas, Georgia and Michigan in 2017, and Hemsley told analysts during a Tuesday morning conference call that his company will not carry financial exposure from the exchanges into 2017.

"We continue to remain an advocate for more stable and sustainable approaches to serving this market," he said.

UnitedHealth moved slowly into this newly created market by participating in only four exchanges in their first year, 2014. But the company then expanded to two dozen exchanges last year and said in October it would add to that total. It currently participates in exchanges in 34 states and covers 795,000 people

A month after announcing its latest exchange expansion, UnitedHealth started voicing second thoughts. The insurer said in November that it would decide by the first half of this year whether to even participate in the market for 2017.

UnitedHealth is one of four insurers to offer ACA plans in North Carolina, and it offers the second-largest coverage area in the state. Blue Cross Blue Shield of North Carolina offers plans in all 100 counties, while Coventry Health Care of the Carolinas and Humana cover only portions of the state.

Insurers say they have struggled, in particular, with customers who have signed up for coverage outside regular enrollment windows and then dumped expensive claims on their books, a problem the government has said it would address.

A dozen nonprofit health insurance cooperatives created by the ACA to sell coverage on the exchanges have already folded, and the survivors all lost millions last year.

Other publicly traded insurers like Aetna have said that they have lost money on this business as well. But some companies, like Molina Healthcare, have said they have managed to turn a profit from the exchanges.

Analysts expect other insurers to also trim their exchange participation in 2017, especially if they continue to struggle with high costs.

UnitedHealth shares jumped 2.2 percent, or $2.79, to $130.60 in morning trading Tuesday. The company also raised its forecast for 2016 and announced first-quarter results that beat expectations.


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