RALEIGH, N.C. (AP) — North Carolina's largest health insurer says higher-than-anticipated costs after two years of selling federally subsidized coverage has forced it to seek premium increases even greater than it thought would be necessary two months ago.
Blue Cross and Blue Shield of North Carolina said Thursday that it now seeks an average 34.6 percent higher premium for insurance sold under President Barack Obama's health insurance overhaul law. The company said in June that it wanted to raise rates by an average of almost 26 percent starting in January, compared with this year's allowed 13.5 percent increase.
The move comes as dozens of health insurers across the country have proposed increasing premiums for individual policies well beyond 10 percent for 2016. However, many of those insurers face pushback from state and federal regulators, and experts say it's still too soon to say how things will turn out.
Blue Cross vice president Patrick Getzen says the program has not met expectations that healthier customers would enroll in the second year and that costs would level out after people who avoided doctors for years got treatment.
"Based on our data, neither expectation is proving true. Our claims and expenses are higher than our premiums and we need to take steps now to protect the sustainability of plans for our customer over the long-term," Getzen said.
Consumers insured through their employers and those continuing individual coverage under policies taken out before the federal Affordable Care Act took effect will not be affected. With more than 3.9 million members in North Carolina, the insurer's policies on the individual market represent a fraction of its overall business.
And it's not clear whether any of these preliminary rate hikes will stick. Regulators in many states have the power to reject price increases, and many who don't are expected to at least pressure insurers to soften their plans. Health insurance price hikes have been the subject of growing scrutiny for years.
Health insurance experts say it's tough to draw broad conclusions about prices from the requests. The health care law only requires insurers to report proposed hikes of 10 percent or more. That's only a partial picture of the market that tilts toward a worst-case scenario.
A recent study by the nonpartisan Kaiser Family Foundation found that while increases for 2016 are generally bigger than they were this year, consumers still should have money-saving options to choose from. The study looked at preliminary data on premiums in major cities across 10 states, plus Washington, D.C.
Researchers found that premiums for a type of lower-cost plan that's used as a benchmark will increase an average of 4.4 percent for 2016. In most cases, consumers would have to be willing to switch plans to get a lower premium.
Blue Cross said it's also retrenching offerings in 16 counties including the Research Triangle and Charlotte regions. The Chapel Hill-based insurer said it will no longer offer there its Blue Advantage and Blue Select plans, which offer broader networks of doctors and hospitals. Getzen said the 55,000 customers affected by the change will be switched to lower-cost, narrow network offerings.
Adam Linker, a health access expert for the North Carolina Justice Center, said he hopes the state's Department of Insurance "takes a hard look" at this rate request.
"There is a question of whether these high rate increases are justified in the short term," Linker said. "There is a lot of uncertainty nationally with insurance companies but I think that companies have a tendency to ask for higher rates than necessary so that they can sort of pad these losses."
Linker said he's concerned that people who are ineligible for federal subsidies will struggle to pay premiums. More than 90 percent of those in North Carolina who bought coverage through a federally run marketplace received federal subsidies that helped them pay the costs.
The federal law changed how health insurance is sold by requiring companies to accept anyone without ruling out some because of existing conditions or healthiness. Policies also were required to cover 10 essential elements including hospitalization and prescription drugs. In return, most adults are required to have coverage or pay a penalty.
Blue Cross in 2014 was the only insurer to sell ACA plans to residents of all 100 of North Carolina's counties.
UnitedHealthcare and Coventry Health Care also offered marketplace policies in North Carolina this year and plan to do so again in 2016. Coventry, a division of Aetna Inc., requested rate increases of between 17.2 percent and 25.8 percent. UnitedHealthcare wants an average 12.5 percent rate increase.