It was just last year when healthcare giants like UnitedHealth and Aetna were exiting out of certain ACA exchanges—citing the ACA as the cause for financial dips in their bottom line. Going into 2017, the exits have continued, and providers were upping premium costs—the latter almost encouraged in the Trump Administration’s latest proposed changes to the ACA. However, things may be looking up.
In a KFF study conducted over the last few years, the financial status of insurers within the exchange appears to be stabilizing. Factors like premium prices, medical loss ratios (MLR), and those who purchased both within the exchange and through ACA-compliant plans outside of the exchange were all taken into consideration. The numbers from 2014 and 2015 were substantial, which may have led to the mass exit in 2016. Take 2014, where the MLR was at 98% (84% in 2013). By the next year, it was at 103%. By 2016, it returned to 96%.
The study punctuated those stats with information surrounding member’s gross margins per month, meaning whatever is left of a premium for providers after the insured’s expenses. The numbers have shifted once again. In 2014, the gross margins were around $7 per enrolled individual, previously $37. In 2015, it was $10, and 2016 it was $14.
According to the KFF, this information—coupled with marketplace enrollment remaining stable and barring any unusual expenses—suggests there may be a financial stabilization within the Marketplace for providers. Will the larger providers finally see the exchange as an opportunity over a threat? We can only hope.
