Some Georgia counties to lose Blue Cross coverage under Obamacare


With open enrollment for Obamacare weeks away, Blue Cross customers across several Georgia counties have received letters from the insurance giant saying their health plan will no longer exist there next year.

Bob Roberts, a radio announcer in Vidalia, thought it was just a renewal letter, he said. “But it wasn’t.”

“I mean what am I going to do?” he asked. “We’re kind of out here in the cold.”

What no one told Roberts is that Georgia still expects every county to be covered by at least one insurance option under the Affordable Care Act, also known as Obamacare. The letter suggested the client call or go to the Obamacare website healthcare.gov to see his or her options; those are not yet posted. Pre-shopping plan information for 2019 coverage is expected to be posted on healthcare.gov shortly, and it will go live for real shopping Nov. 1.

The letters from Blue Cross apply to customers on the individual market, including the ACA exchange.

See a copy of Blue Cross’ letter here.

The last-minute news shook agents and customers in the individual market, raising the specter of uncertainty that has jostled the individual market over the past couple of years. At that time, as the Trump administration focused on its campaign promises to undo pieces of Obamacare with help from the GOP-led Congress, insurance companies said they had to raise prices and pull back coverage to compensate for the market uncertainty.

This year, in contrast, announcements for 2019 coverage had been largely sanguine. Rates are expected to stay stable, companies are expanding coverage and Blue Cross is returning to metro Atlanta. Although struggles continue over the ACA, including a lawsuit filed by states including Georgia, companies appear to have baked that uncertainty into their prices now.

The company told The Atlanta Journal-Constitution in a statement that it revised its 2019 Georgia coverage proposals after a thoughtful review. “This was a difficult decision,” Blue Cross told its clients in the letter, “because we’re committed to offering you and your family affordable health benefits.”

The move came after companies filed their initial plans and could see what their competitors offered. Health insurance companies make their first proposals to the Georgia Department of Insurance for rates and coverage in early or midsummer; then they negotiate with the state for a final proposal by August. Those proposals rarely change afterward, but they can and have.

Blue Cross now expects to serve only 75 of the state’s 159 counties in 2019fewer than it originally proposed. State officials point out that it will still serve more people than in 2018 because it’s adding back populous counties that it had left.

“Overall, there’s slightly more competition,” especially from the Atlanta area northward, said Tom Carswell, the director of the product review division of the state Insurance Department. “There’s more coverage in more counties than there was last year.”

And, he added, all counties will have coverage. Companies such as Ambetter expanded into other counties, allowing Blue Cross to draw back without leaving a county dry.

The reason for the withdrawal likely comes down to money.

One of the major factors for insurance companies isn’t just how much money it can make from the customer base in a given county, but how good the contracts are that it’s able to strike with hospitals and doctors in a given geography.

In areas with fewer health care providers, the providers might have more bargaining power, and that can make the contracts less lucrative.


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