Blue Cross Blue Shield of Texas Requests 60 Percent Higher Obamacare Rates

Blue Cross Blue Shield of Texas has requested increases of 57 percent to 59 percent on the plans it offers on the Obamacare exchanges.

The Richardson-based insurance plan submitted the requests last month, which regulators must approve before they can be enacted. The next enrollment period begins in November. Blue Cross Blue Shield of Texas is the state’s largest insurer and the only payer that offered plans in all 254 counties. Its losses were reflective of that effort. Last year, it removed its more broad PPO plans from the marketplace and proposed 20 percent rate hikes. In the past two years, it has lost about $1 billion on the exchanges—$592 million in 2015, and $416 million in 2014, according to its filing.

Its parent company, Chicago-based Health Care Services Corporation, has lost more than $2 billion on its plans in Texas, Oklahoma, New Mexico, Illinois, and Montana. The customers were sicker and used their coverage more than the plans expected, and claims far outpaced the premiums brought in. In New Mexico, HCSC pulled its plans after insurance regulators refused approving a 53 percent hike.

“You can look at a number, like, 3 percent seems like a reasonable increase, but that 3 percent could be tacked on an unreasonable rate,” Kenneth Avner, the company’s chief financial officer, said in an interview back in March. “You could have something that sounds totally unreasonable at 30 percent on a reasonable rate. The market is intended to give the consumer the option to shop, and until you put all the products side to side and let the consumer make the decision, talking just about rate increases does not tell the whole story.”

About 87 percent of consumers qualify for some sort of subsidy on the exchanges, meaning they won’t be paying the whole price increase out of their own pockets. The rate hikes also have yet to be approved, and will undergo a period of hearings and public comments.

The insurer released the below statement:

“The rates we have submitted for review and approval, are supported by strong actuarial principles, science and data. The rates that health insurers currently charge vary and are based on several factors including medical care costs for a region, pharmaceutical cost and utilization, among other variables. The anticipated health risk of the people in any given market is the largest component of determining rate changes.  Additionally, rates may also differ based on whether an individual is purchasing insurance directly or through his or her employer.

Posted in Insurance/Benefits, News.