Aetna exit means Pinal County has no marketplace health plan


People in Pinal County are at risk of a health insurance problem that hasn't happened anywhere else in the country: no companies offering marketplace health insurance. Healthcare providers say without the subsidized coverage, thousands of Pinal County residents could be priced out of health insurance.

The nation's third-largest health insurer announced it was pulling out of public exchanges in all but four states. Aetna had been the last insurer planning to offer Affordable Care Act plans in Pinal County for 2017.

The move has patients who get insurance from the public exchange wondering where they'll turn.

"One of them, I talked to him on the phone today, he's like, 'Does this mean I have to move? I have to go to a different county?" said Maria Villalobos, an employee at Sun Life Family Health Center in Casa Grande who is licensed to help people navigate the health insurance marketplace.

As of February, 9,667 people in Pinal County were using a marketplace plan, according to data from the U.S. Department of Health and Human Services.

The vast majority of those residents -- 88 percent -- qualify for a subsidy, according to Renee Louzon-Benn, director of community outreach at Sun Life Family Health Center. The average subsidy is $230 per month, she said.

"Imagine your income qualifies you for a $230 per month discount on insurance. And imagine now you lose that and you're forced to go buy insurance," she said. "I just can't imagine being faced with that decision."

Added Villalobos, "You're going to see about 10,000 people who do not have access to care. Access to doctors, access to prescriptions."

Blue Cross Blue Shield of Arizona and UnitedHealthcare currently offer plans in Pinal County, but United is pulling out of Arizona and Blue Cross is not offering plans there next year.

Arizona Insurance Department spokesman Stephen Briggs said Tuesday that Blue Cross filings would allow it to offer Pinal County plans in 2017, if the company chose to do so. He said there is an Aug. 23 deadline.

Blue Cross said in a statement that "Arizona is now an example of what happens when the market is unstable," but didn't immediately comment on whether the company would step in.

"We are re-evaluating our 2017 plans and where Blue Cross Blue Shield of Arizona makes coverage available," the statement said. "Our leadership team is in the process of speaking with regulators in light of the recent news of Pinal County residents having no options."

Pinal County residents will have some off-marketplace options, but those don't qualify for federal subsidies many receive to help pay their premiums, Briggs said.

The announcement by Aetna late Monday adds to pressure on the exchanges that are a key part of President Barack Obama's health care overhaul law. Companies are citing losses on the exchanges because older, sicker-than-expected people are signing up for insurance, and not enough young and healthy people are buying coverage.

"This is a graphic demonstration of the utter failure of Obamacare," said Republican Senator John McCain. "There's no doubt, because of the fundamental problems of Obamacare, there will be other states in America, and other counties in Arizona that will be facing the same dilemma."

Health insurance companies that sell individual policies on the federal marketplace in Arizona are planning major premium increases for 2017, and Arizona is no exception.

In June, insurers filed notices with the Insurance Department seeking average increases of 8.7 percent to as much as 65 percent. Those numbers have since been revised upward, with insurers planning 19 percent to 122 percent premium boosts.

People who qualify for federal tax subsidies are shielded from the big increases. But higher-income people have to pay the entire amount.

As of December, about 155,000 Arizonans had coverage through the marketplace. The federal Centers for Medicare and Medicaid Services said 203,000 Arizonans had signed up for policies in 2017 but there's no way to determine how many of them have actually paid their premiums. The six insurers who filed for rate increases listed about 140,000 customers.

More than 12 million people nationwide get insurance from the marketplace. The coming year will be the fourth for the markets, and each year has seen dramatic shifts in Arizona's plans and premiums.Copyright 2016 KPHO/KTVK (KPHO Broadcasting Corporation) and The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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