ACA Government Co-Ops: Is This Experiment Working In Your State?

[AllenChicago]

AC,

It is permissable. The TN co-op did that in 2015.

The same co-op that is now kaput.

They are not technically withdrawing from the marketplace, just closing to new enrollment.

And watch out with that. If they lose subsidy for not reconciling or not getting docs in or whatever the marketplace will not let them back on the same plan even after fixing that, they will have to go with a new carrier. Had that happen to a couple last year.

So that's how they get around the rule against mid-year withdrawal. Thanks TN-Agent. You can tell there's HHS blood running through the veins of these co-ops by the way they use language to circumvent rules.

So, what's preventing UHC from "suspending" Marketplace sales? They want out too. Most (all?) carriers do.
ac

 

[somarco]

Co-ops are his creation. But appropriation bills are not. He can wish all he wants but Congress shut the funding off.

Name one thing Obama wanted that he did not get from Congress.

 

[RayNY]

Health Republic, which failed, is now $200 million or more in debt to providers.

Lawmakers are having hearings on the topic at the capitol.

UHC indicated that their rates are too low in NY in light of HRINY's failure, and the lack of risk-adjustment payments. Applied for 22% increase, but the DFS only allowed 1.65%. Applied for 5.32% increase under the Oxford brand, but got a 12.25% CUT (can you believe that?)

UHC has a track record of accurately predicting costs. For their premium to be forced 20% lower than they want strongly implies the DFS doesn't care and just wants to artificially keep rates low even if it means putting more companies out of the market. UHC is now on record saying they regret entering the ACA marketplace before it stabilized.

They're now on track to lose hundreds of millions.

 

[AllenChicago]

February 25, 2016

HHS's Mandy Cohen told a Congressional committee today that 8 of the 11 remaining Co-Ops are in serious danger of not making it to the end of 2016. The medical providers that accept patients with health insurance provided by Co-ops that go under may never get their money, because the ACA requires the U.S. government to be repaid first, when a Co-Op closes its doors.

Full Story: Eight of 11 Surviving Obamacare Co-Ops Facing Failure | The Daily Caller

 

[somarco]

This game looks familiar.

https://www.youtube.com/watch?v=o2kO_5cNF5k

 

[RayNY]

8 of them are currently under enhanced oversight or corrective action?

That's what happened to the failed co-ops after they had already failed and were winding down, isn't it? AFAIK, only two are projected to be profitable this year, and only one was profitable last year.

In other news, CMS is attempting to recoup grants given to failed co-ops. I guess no one informed them that there's not enough to even pay claims, let alone, commissions/bonuses.

Meanwhile, Health Republic of Oregon is filing a class action lawsuit against the federal government to the tune of $5 billion dollars. I guess they hope to re-start the co-ops?

 

[Tkruger]

Meanwhile, Health Republic of Oregon is filing a class action lawsuit against the federal government to the tune of $5 billion dollars. I guess they hope to re-start the co-ops?

The class action suit is due to the risk corridor payments that were promised that never came to fruition.

 

[RayNY]

The class action suit is due to the risk corridor payments that were promised that never came to fruition.

You're correct. However, as far as I know, according to the law, they are not guaranteed and there's no provision requiring or allowing the federal gov't to dip into other reserves to cover a shortfall.

They're suing for $5B when all co-ops combined filed for $2.87B, and expect the payments to go to 11 co-ops that are no longer in business. Co-ops that CMS is currently trying to recoup grant money from.

The attourney representing them, Stephen Swedlow, is where the "hope to re-open" comes from. The article notes he "hopes the lawsuit will allow co-ops to keep functioning."

IMO, neither effort will get far.

 

[AllenChicago]

May 26, 2016

Is this our first Co-Op failure of 2016?

OHIO's InHealth Mutual has been ordered to shut down by the ODOI.

"By Peter Sullivan - 05/26/16 04:49 PM EDT

A nonprofit health insurer in Ohio set up under ObamaCare is going out of business, regulators announced Thursday. It is the latest in a string of failures for “co-op” health plans.

The Ohio Department of Insurance announced that the co-op, known as InHealth Mutual, will be shut down, forcing its nearly 22,000 enrollees to find other plans within the next 60 days.

“Our examination of the company’s financials made it clear that the company’s losses would prevent it from paying future claims should its operations continue,” Lt. Gov. Mary Taylor, who is also the Ohio director of insurance, said in a statement."

Source: Ohio ObamaCare co-op shutting down due to finances | TheHill

I think there are just 6 left, of the original 22 Co-ops? It's not even worth updating that list of failures any more. Most likely, there will only be 2 or 3 left when 2017 arrives. I wonder if the weakest Co-ops are submitting plans for 2017, knowing in their gut that the weight-challenged lady is about to sing?

 

[jefflange]

I received a memo yesterday. Looks like Ohio's Co-Op IN-HEALTH - Coordinated Health Mutual, Inc is done.
Appears to be going into receivership.
Another One bites the dust.
Oh, I guess Allen just posted on Ohio, My bad