Lower premiums for Blue Cross ACA health plans forcing thousands to switch doctors

But the effort comes at a cost to about 50,000 customers who will have to change doctors and hospitals at the end of the year because Blue Cross is eliminating its Blue Local plan, which was affiliated with Duke Health and WakeMed.

Instead, Blue Cross wants people with Affordable Care Act coverage to shift to the Blue Value plan, which is part of a new contract with UNC Health Alliance, a physician-led network that includes independent and UNC Health Care providers. Blue Cross says the contract offers lower premiums while maintaining similar benefits to existing plans.

Rick Carrico, executive vice president and chief financial officer for WakeMed, said the health care system is "incredibly disappointed" by Blue Cross' move. WakeMed offered substantial discounts to Blue Cross to maintain part of the Blue Local plan, he said.

"We are working closely with Blue Cross NC to minimize the impact on our patients and to ensure those with certain ongoing, acute, chronic or terminal conditions (including pregnancy) can continue to receive the care they need without interruption after January 1," Carrico said in a statement. "Our leadership team is working closely with another national insurance carrier that offers health exchange products across the country to provide a competitive ACA exchange option that includes WakeMed and Duke. We hope to share details about this plan very soon."

Blue Local customers who don't want to switch to UNC Health Care providers would have to pay out-of-network costs or pay for a non-ACA plan.

Blue Cross is "committed to working with our current Blue Local customers to help them find a new in-network provider and to make sure they continue getting the care they need throughout this transition," spokesman Austin Vevurka said in an email.

WakeMed and Duke Health remain in-network for other Blue Cross plans, such as Medicare Advantage, the State Health Plan and many Blue Advantage, Blue Select and group plans.

Duke Health officials didn't respond to a request for comment.

Blue Cross said new contracts with health care providers across North Carolina will help control costs and allow the insurer to cut its rates on individual ACA plans purchased through the HealthCare.gov marketplace.

The requested rate decrease, which still must be approved by the state Department of Insurance, would average 4.1 percent. Although some areas may see a rate increase, all requested county increases are less than 10 percent, officials said.

"This is the first individual market rate decrease in Blue Cross NC history and will benefit people across North Carolina," Dr. Patrick Conway, Blue Cross' president and chief executive, said in a statement. "We’re moving in the right direction, but even with a lower rate, premiums are still too high, particularly for those who don’t get a subsidy. With more certainty from Washington, rates would be 15 percent or more lower. We must address both market instability and the rising price of health care."

During the first three years of the ACA's online marketplace, Blue Cross lost more than $450 million, but officials said they have been able to gain more information about the pool of customers, including how to help manage their care, reduce their medical expenses and price health plans to fit their needs.

Blue Cross is the only insurer to offer ACA plans in all 100 North Carolina counties, providing coverage for more than 475,000 customers. About 90 percent of those customers receive federal subsidies to lower their premiums.

Congressional action both helped and hurt ACA rates, Blue Cross officials said. Savings from federal tax cuts and a one-year suspension of the ACA's Health Insurer Tax combined to lower rates by 3.5 percent, but rates could have been lowered by another 4 percent if Congress hadn't eliminated the ACA's requirement that everyone purchase health insurance or face a tax penalty. Congress' decision to halt federal cost-sharing reduction payments to insurers cost consumers another potential 14 percent rate reduction, officials said.