A case of whiplash at Obamacare exchanges

The health care seesaw continues. 

On the GOP side, you've got the proposal from Sens. Lindsey Graham, R-South Carolina, and Bill Cassidy, R-Louisiana. It's a last-gasp effort to repeal the Affordable Care Act subsidies with block grants to the states, severely cut Medicaid and eliminate the individual mandate.

On the other side, you've got Sen. Bernie Sanders, I-Vermont, with his Medicare for All plan, which would eventually expand the existing system that covers about 55 million senior Americans to all citizens.  

As consumers ponder the pendulum swings in Washington, many are taking a short-term view, wondering what they'll do this fall when they sign up for the 2018 ACA exchanges. The status of the ACA marketplace in many states continues to ebb and flow as the Sept. 27 deadline for insurers to commit to exchange participation comes close.

In recent weeks, several state insurance officials and governors in states such as Ohio and Nevada have negotiated with insurers to make sure coverage continues for all citizens. At the same time, giant premium increases are rampant as insurers grapple with the uncertainties surrounding the future of government support for the individual marketplace.

The latest example of the crazy back and forth is in Virginia. In early September, it seemed all states, including Virginia, had managed to make sure there was at least one insurer in every Obamacare exchange. This was good news.

But shortly after insurance commissioners and consumer advocates were celebrating that fact, Optima announced it was pulling out of the Virginia exchanges, leaving 63 out of the state's 95 counties without an insurer. Optima had stepped in to fill the gap major insurer Anthem (ANTM) left after it announced in August it was leaving the Virginia state exchange business. Both companies cited uncertainty over federal government support for the exchange program as at least one reason for leaving.

Just last week, Anthem, after long negotiations with Virginia officials, announced it would return to Virginia to fill in the blanks Optima left behind. The comeback comes with a price. The monthly premiums for the new plans will increase by 42 percent to 64 percent, according to the company's amended rate filing with the Bureau of Insurance, as reported in the Richmond Times-Dispatch.

As Virginia shows, a game of chicken is going on as insurers and states wait to see what, if anything, the Trump administration will do with federal cost-sharing payments before the late September deadline. These payments are used to lower out-of-pocket health care costs for low-income exchange members. The Trump administration has committed to paying these subsidies through September, but not beyond.

Without these payments, insurers argue they must charge higher premiums to offset the increased costs. Thus the back and forth now going on between insurers and state officials.

Earlier this month, Sens. Lamar Alexander, R-Tennessee, chairman of the Senate's health committee, and Patty Murray of Washington, the committee's top Democrat, introduced legislation that would help preserve cost-sharing subsidies for a longer period of time. But those efforts have faded in the resurgence of the GOP's Graham-Cassidy bill, leaving insurers more uncertain than ever about cost-sharing subsidies just as the deadline looms.