CHEYENNE - The recent announcement that WINhealth will pull out of Wyomings health insurance marketplace next year means thousands of people will have to re-enroll for insurance.

On Thursday, WINhealth issued a release saying that it does not intend to offer insurance through the federal marketplace for 2016. Existing customers covered under the Affordable Care Act will still be insured through WINhealth through Dec. 31, but theyll be on their own afterward.

In its release, WINhealth cited new costs coming from the Centers for Medicare and Medicaid Services as a big factor in its decision. The company said CMS recently established a risk corridor program that aims to balance costs to insurers by requiring companies that take in more than they pay out to put money into the risk corridor program.

That money would then be given to insurers who pay more in claims than they take in. But WINhealth said the rate of repayments was too uncertain to guarantee it could continue meeting its cost obligations.

The financial impact of the federal governments decision on WINhealth amounts to approximately 4.4 million, WINhealths statement read.

The ambiguity of federal government repayments, both in timeline and amount, have created an environment of uncertainty and increased risk in the individual environment.

Its decision to pull out of the federal marketplace means about 8,200 people currently covered under WINhealth will have to look for a new insurer. But they wont have to look far, since there is only one in-state option for health insurance left: Blue Cross Blue Shield of Wyoming.

Wyomings new situation is not unprecedented. In West Virginia, Highmark Blue Cross Blue Shield was the only insurance provider on the states federal marketplace exchange through 2014 and 2015, though thats set to change next year with CareSource offering plans across 15 of the states 55 counties.

Still, its rare to find a state with just one company offering insurance through the federal exchange. Part of it has to do with the unique challenges insurers face in Wyoming, with its small, spread-out population making it difficult and more expensive to provide regular and emergency health-care services consistently.

But Jeff Rude, deputy commissioner for the Wyoming Department of Insurance, said just because WINhealth is pulling out of the market doesnt mean the sky is falling for Wyomings uninsured.

Certainly more choice is better than less choice, Rude said. Obviously this isnt a good thing. But for consumers, itll be business as usual.

Rude said its important to remember that the ACA has explicit cost controls in place, meaning just because Blue Cross Blue Shield is the only game in town, the company wont be able to exploit that fact to its benefit.

In the end, CMS looks to ensure at least 80 cents of every dollar spent (on health insurance) goes to claims, Rude said. One company cant just raise its rates arbitrarily.

While Wyomingites already do pay some of the highest health insurance premiums in the country, WDI senior policy analyst Denise Burke said thats not because insurance companies have been trying to soak consumers.

The insurance rates are set by the cost of health-care delivery, not the other way around, Burke said. Furthermore, in some states the rate setting is done by the Department of Insurance; but in Wyoming, its done by CMS. And theyve already set the rates for Blue Cross Blue Shield for 2016.

Rick Schum, the president and CEO of Blue Cross Blue Shield of Wyoming, added that while those new rates wont be made public until the next ACA open enrollment period, WINhealths departure will have no bearing on them.

It has no impact at all on any function of our rate setting, Schum said.

If reassurance is what were looking at, I would highly doubt any of our customers - or future customers - are in for any sticker shock.

And despite being the state exchanges only remaining health insurance provider, Schum said Blue Cross Blue Shield attempts to provide a wide range of coverage options, rather than a one-size-fits-all plan.

We wanted to make sure people have a choice, he said.

So we tried to arrange an array of products that addresses individuals needs; were offering 28 different products through the insurance exchange.

Even so, Rude said he acknowledges the importance of healthy competition in Wyomings insurance marketplace. He said the Department of Insurance has been in talks with several out-of-state providers interested in joining the states exchange as early as 2017.

Weve also talked with some individuals with CMS whove said that they will do whatever they can to encourage them to come here also, Rude said. So there are people that are looking at our market.

But, in the short term at least, Burke said that anyone who is currently enrolled with WINhealth through the federal exchange will have to re-enroll through Blue Cross Blue Shield if they want to stay covered. To that end, she said, WINhealth customers should consider reviewing their options at www.healthcare.gov or by calling Wyoming 211 for assistance.

Right now they can still see their medical providers; coverage is there. But anything that occurs after Dec. 31 is a different consideration, Burke said.

During open enrollment, those people will need to enroll in a new plan, and theyll need to enroll in a plan before Dec. 15 in order to have a plan in place by Jan. 1 of 2016.

Open enrollment for 2016 coverage begins Nov. 1 and runs through Jan. 31.


Published on: Friday, Oct 09, 2015 - 11:48:40 pm MDT