Blue Cross pulls back on Georgia coverage

Citing federal uncertainty, Blue Cross Blue Shield will not offer individual health insurance coverage in metro Atlanta in 2018, the company said Monday. And it came perilously close to withdrawing entirely from Georgia’s individual market, documents show, but decided to stay in the state after intense negotiations.

In 96 of the state’s 159 counties, Blue Cross is currently the only company keeping the Obamacare health insurance exchange market alive. It currently covers the entire state but is about to pull back, leaving the Georgia exchange with a patchwork of companies that blankets the state.

That doesn’t help Marc Morton, a Cobb County resident whose wife and daughter have pre-existing conditions and get their insurance from Blue Cross on the exchange. “My wife was in panic,” he said. “I looked at it and I thought, well this is just something that has to be overcome somehow.”

Blue Cross was clear about its reasons.

“Unfortunately, continued regulatory uncertainty at the Federal level and the current state of instability in the individual market have necessitated that we consider discontinuance of certain of our current offerings,” Jeff Fusile, the president of Blue Cross and Blue Shield of Georgia, wrote in a letter to the state explaining the move. He wrote the letter in June, but Blue Cross made the announcement to customers Monday.

The move applies to the individual market and doesn’t affect people who get insurance through their company group plans. Blue Cross, whose parent company is Anthem, reserved the right to make further changes by the end of September.

Health care policy in Washington has careened in recent months from one proposal to another, and the uncertainty continued even up to this past weekend. On the sidelines of the Obamacare repeal drama, the White House has threatened to withhold subsidy payments that help exchange markets function under the health care law. Just last week, Kellyanne Conway, an adviser to President Donald Trump, said the president would make a decision one way or another on the payments last week; but the weekend arrived and he had not.

Asked by The Atlanta Journal-Constitution whether the president had actually intended to make such an announcement, a White House representative said Trump was working with his staff and his Cabinet to consider the issues raised by the payments.

At present, Blue Cross’ plans are still to fill the rural gaps in Georgia’s Obamacare exchange left by other insurers who withdrew. But in a turnabout, Blue Cross is withdrawing from areas that are already covered by other insurers and typically seen as easier to cover — such as metro Atlanta. Such a move would mark the first time in decades that Blue Cross did not provide individual coverage in the Atlanta area, the company said.

Blue Cross is remaining only in counties where it has no competition. In 85 Georgia counties Blue Cross will be the only company insuring customers on the Obamacare health insurance exchange in 2018. A different company, Ambetter, is stepping in as the only insurer in 11 counties Blue Cross is leaving.

Ambetter also intends to offer individual plans in metro Atlanta.

The news sent a convulsion through Blue Cross’ world of customers and agents Monday.

“I’m scared,” said Kirk Lyman-Barner, who sells exchange plans in southwest Georgia. “I have the same size book of business to service no matter who fills in. We have to adjust. I’ve hired a partner to help sell. Is that going to impact those hiring decisions? Are commissions going to be there for that?”

Lyman-Barner had been particularly jolted by Trump’s tweet that the subsidy payments are “BAILOUTS” and Conway’s statement that the president would make a decision.

It’s also personal. His wife is covered by a Blue Cross exchange plan. She went in for a pair of routine operations and was advised by her surgeon that she should space them out and not have the second one so soon.

“She said, ‘But I don’t know what the GOP’s going to do to my health insurance,’ ” Lyman-Barner said. “The surgeon looked at her and said, ‘You’re probably right.’ ”

GOP leaders, however, have said uncertainty is the failure of the Obamacare law itself. Georgia’s GOP senators voted for its repeal several times. After repeal failed, Georgia U.S. Sen. David Perdue said in a statement that “throughout this entire process, we have witnessed everything that’s wrong with Washington.”

On Monday, a spokeswoman responded to the Blue Cross news with a similar message. “All along, Senator Perdue has warned Obamacare is collapsing under its own weight and he is working to fix our health care system,” said Caroline Vanvick, Perdue’s spokeswoman.

Morton called himself politically an independent. When he got the Blue Cross email Monday, he thought, “We’ll figure out a way.”

However, he added: “If you’d been watching the debates over the summer, it was exactly what my fear was. They were not going to do anything and allow the marketplace to just crumble. I know there’s a bipartisan effort now in Congress to shore up the market. … I don’t know how long that will take, but obviously the insurers are saying it’s not good enough.”

Morton said the system just needs to be fixed, and officials in Washington need to stop playing politics with it: “I think they’re not fully embracing the human cost.”