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3 Metro East counties down to 1 insurer on Affordable Care Act exchanges

Angela Merten is an in-person assister for the federal online marketplace at Touchette Regional Hospital. But she says most of the people she'll help sign up for health insurance will qualify for Medicaid under Illinois' expanded program.
File photo |St. Louis Public Radio
In a file photo from 2014, Angela Merten sits with enrollment applications at Touchette Regional Hospital in East St. Louis

The eastern St. Louis metro area has been particularly hard hit by health insurance companies exiting the Affordable Care Act exchange. This week, the federal government released prices for 2017, which include substantial increases in western Illinois.

Insurance brokers in Belleville say three Metro East counties — St. Clair, Madison and Monroe — will have just one insurer to choose from this year: Blue Cross Blue Shield.

Tom Ripperda, an agent in Belleville, said that will mean higher premiums and narrower networks for many of his clients.

“A monopoly in a county I don’t think is good for the consumer, nor good for the hospitals or doctors,” Ripperda said. “In order to stay with a network, they may have to use a hospital they normally don’t go to or change doctors, which is usually pretty traumatic.”

An average, pre-subsidy premium for a 40-year-old nonsmoker in Illinois on a benchmark silver plan will go from $198 to $291 a month, according to an analysis by the Kaiser Family Foundation. Though federal subsidies are increasing alongside the higher premiums, people incomes higher than four times the federal poverty line ($24,300 for a family of four) will still be on the hook for the added cost.

“We expected they would go up. I didn’t not expect it would go up 75, 80 percent,” said Tina Gallagher, an insurance broker in Columbia, Ill. “We have a lot of folks — small business owners — who don’t qualify for tax credits, they’re really going to feel the pain of this.”

There are a few reasons why the Affordable Care Act exchanges have struggled: insurance companies had a hard time determining how to price plans in the early years of the exchange, about half as many people signed up for coverage as had been projected by the Congressional Budget Office in 2014 and the companies complain that they are losing money.

“Three health plans have been dropping out: Aetna, Humana and UnitedHealthcare in various areas,” said Washington University health economist Tim McBride. “Our analysis, and other analyses show that when there’s less competition the premiums go up.”

People seeking coverage in Illinois also lost the Land of Lincoln Mutual Health Insurance Co. this year, when the co-op that had been established under the Affordable Care Act closed after steep losses.

In Missouri, premiums are higher but the increase is lower: benchmark silver plans for a 40-year-old nonsmoker, on average will go from $287 to $310 before income-based subsidies. 

Open enrollment on Healthcare.gov starts on Nov 1.

Follow Durrie on Twitter: @durrieB