Withdraw of Insurers from ACA Markets Leaving Many Southwest Patients with Few or No Choices

Thirty-one percent of the nation’s counties are projected to have only one insurer offering health plans on the Affordable Care Act’s (ACA) exchanges next year, according to the nonpartisan Kaiser Family Foundation (1). Another 31% are projected to have only be only two. Most of the likely one-insurer counties are predominantly rural (Figure 1).

Figure 1. Estimated number of insurers participating in Affordable Care Act exchanges by county, 2017.

Particularly hard hit is Arizona where most of the rural portions of the state will have only one insurer and Pinal County will have none. Rural Nevada is similarly affected along with Utah, Wyoming, Oklahoma and much of the Southeast US.

That would give exchange customers in large areas of the U.S. far less choice than they had this year, when only 7% of counties had one insurer and 29% had two (Figure 2).

Figure 2. Net changes in number of insurers compared to 2016.

Many insurers are losing money on the health plans they sell through the exchanges. Insurance giants UnitedHealth, Humana, and Aetna have cited heavy losses as the reason for withdrawing from ACA marketplaces (2). The insurers that remain are in some cases seeking sharp premium increases for next year, trying to get back in the black amid higher-than-expected costs.

The marketplaces were supposed to hold down prices and expand choice by fostering competition among insurers. A concern when the exchanges were set up was that they might eventually reach the "tipping point". This is the point where too many sick patients with high health care costs are enrolled in the exchanges. Their high costs lead to higher insurance premiums driving the young and healthy enrollees out of the exchanges. According to the insurers the young and healthy enrollees low costs are necessary to balance out claims ledgers. President Obama has called for the creation of a public insurance option to compete alongside private plans in places where competition is limited.

References

1. Cox C, Semanskee A. Preliminary data on insurer exits and entrants in 2017 affordable care act marketplaces. Kaiser Health News. August 28, 2016. Avialble at: http://kff.org/health-reform/issue-brief/preliminary-data-on-insurer-exits-and-entrants-in-2017-affordable-care-act-marketplaces/ (accessed 8/29/16).
2. Mathews AW, Armour S. Health insurers’ pullback threatens to create monopolies. Wall Street Journal. August 28, 2016. Available at: http://www.wsj.com/articles/health-insurers-pullback-threatens-to-create-monopolies-1472408338 (accessed 8/29/16).

Cite as: Robbins RA. Withdraw of insurers from ACA markets leaving many southwest patients with few or no choices. Southwest J Pulm Crit Care. 2016;13(2):97-8. doi: http://dx.doi.org/10.13175/swjpcc085-16 PDF 

Hospital Executive Compensation Act Dropped from Ballot

The Hospital Executive Compensation Act did not qualify for the November 8, 2016 ballot in Arizona as a state statute (1). The Service Employees International Union (SEIU) dropped the initiative just before arguments were to begin in a lawsuit that challenged the legality of signature gatherers who failed to register with the state. The measure would have limited total pay for executives, administrators and managers of healthcare facilities and entities to the annual salary of the President of the United States. A similar measure in California was also dropped by the SEIU in 2014.

Supporters of the proposal said it would decrease escalating healthcare costs. Opponents of the measure, including the Arizona Chamber of Commerce who filed the suit challenging the proposition, alleged that it would lead to poorer healthcare. However, a survey conducted by the Southwest Journal of Pulmonary and Critical Care showed that most supported the measure and felt that it would not lead to poorer healthcare (2).

References

1. Ballotpedia. Arizona hospital executive compensation act (2016). Available at: https://ballotpedia.org/Arizona_Hospital_Executive_Compensation_Act_(2016) (accessed 8/22/16).
2. Robbins RA. Survey shows support for the hospital executive compensation act. Southwest J Pulm Crit Care. 2016;13:90. [CrossRef] 

Cite as: Robbins RA. Hospital executive compensation act dropped from ballot. Southwest J Pulm Crit Care. 2016;13:91. doi: http://dx.doi.org/10.13175/swjpcc081-16 PDF

Smoking Rates Low in Southwest

The Gallup survey confirms that smoking rates in the US are declining and that smoking rates are lower in the Southwest than the US as a whole (1). Nationally, the smoking rate fell to 19.7% in 2013 from 21.1% in 2008. Among the Southwest states California ranked second (15.0%), Colorado ninth (17.4%), and Arizona tenth (17.5%). Only New Mexico was above the Nation's average at 20.0%. Utah remains the state with the lowest percentage of smokers, 12.2 percent, and Kentucky the highest, 30.2 percent.

Nine of the 10 states with the lowest smoking rates have outright bans on smoking in private worksites, restaurants, and bars, with California allowing for ventilated rooms. Bans are significantly less common in the 10 states with the highest smoking rates. Kentucky, West Virginia, and Mississippi -- the states with the three highest smoking rates -- do not have statewide smoking bans. In addition, these three states have some of the lowest average cost of a pack of cigarettes (2).

The Campaign for Tobacco-Free Kids has identified access to tobacco as a major factor in youth smoking (3). However, tobacco products still remain readily accessible. Recently, CVS, the National chain of pharmacies, announced that it will no longer sell cigarettes (4). A recent New York Times op-ed called for Walgreen’s to do the same (5).

Richard A. Robbins, MD

Editor

References

1. McCarthy J. In U.S., Smoking Rate Lowest in Utah, Highest in Kentucky. Available at: http://www.gallup.com/poll/167771/smoking-rate-lowest-utah-highest-kentucky.aspx?utm_source=rss&utm_medium=rss&utm_campaign=in-u-s-smoking-rate-lowest-in-utah-highest-in-kentucky-smoking-rate-in-alaska-has-dropped-the-most-since-2008 (accessed 4/12/14).
2. Boonn A. Campaign for tobacco-free kids. Available at: https://www.tobaccofreekids.org/research/factsheets/pdf/0202.pdf (accessed 4/12/14).
3. Campaign for tobacco-free kids. Enforcing laws prohibiting cigarette sales to kids reduces youth smoking. Available at: http://www.tobaccofreekids.org/research/factsheets/pdf/0049.pdf (accessed 4/12/14).
4. CVS quits for good. Available at: http://info.cvscaremark.com/cvs-insights/cvs-quits (accessed 4/12/14).
5. Bach PS. The tobacco ties that bind. New York Times. 4/10/14. Available at: http://www.nytimes.com/2014/04/11/opinion/the-tobacco-ties-that-bind.html?_r=0 (accessed 4/12/14).

Reference as: Robbins RA. Smoking rates low in southwest. Southwest J Pulm Crit Care. 2014;8(4):233. doi: http://dx.doi.org/10.13175/swjpcc051-14 PDF