Thought this was interesting ... from an article talking about a Minn company being the only provider left in the Iowa and Nebraska individual marketplaces.


http://www.startribune.com/as-health-ins...425830563/

Quote:In Iowa and Nebraska, Connecticut-based Aetna announced this spring the insurer wouldn't return for 2018. The Blue Cross plan for Nebraska dropped out of the exchange market at the end of 2016 citing $140 million in losses, and Wellmark — the Blue Cross and Blue Shield insurer in Iowa — said in April it would stop competing next year.

It's possible that other carriers could enter the Iowa and Nebraska markets, but exits have been much more common across the country.

"We have community members in those states that have significant needs. There's a threat of not having any insurance coverage," John Naylor, the Medica chief executive, said in an interview. "Our team has the mentality and spirit to go in and fight that battle, to try and help the communities have a viable option."

But Naylor added: "We can't do it alone."

In Iowa, the insurer wants policymakers to shore up the market with measures like a "reinsurance" program that would help cover costs for people with expensive health conditions. Earlier this year, Minnesota agreed to create such a program.

In addition, Medica is promoting the idea of a "virtual high-risk pool" to spread the costs for a handful of patients whose care costs millions of dollars per year. When explaining the health plan's decision to drop the Iowa market, Wellmark officials mentioned the unusual case of a patient generating more than $1 million per month in claims — an enrollee subsequently described as a 17-year-old with hemophilia.

Medica officials said they could not comment on the particular case, except to say there's the potential for a few patients like that in every state.

"The question, socially, comes back to: Who actually should be helping that individual?" Naylor asked. "Is it a broader pool of people that are insured? Is it the state? Is it the federal government? ... Right now the costs are being borne by the people in the individual market, and that's what's causing part of the issue."

Without changes, it would be extremely difficult for Medica to assume the entire risk of the Iowa individual market, said Geoff Bartsh, a vice president with the insurer. The health plan is more comfortable with the Nebraska market, he said, because Medica already has a larger share of the market. Plus, there's a degree of competition, since Blue Cross of Nebraska still sells individual market coverage to people who buy outside the government-run insurance exchange.

Last week, Medica suddenly found itself needing to make yet another decision about whether to stick with its out-of-state exchange business. For 2017, the insurer expanded into the individual market in Kansas, but last week Medica's only competitor in two large Kansas counties announced it would be dropping out.

"We want to be in these markets," Naylor said. "But it's not just up to Medica. We need state legislators and regulators to come up with solutions. We need support from the federal government."