Blue Cross NC is seeking approval to lower Obamacare rates for its customers again

Published: Aug. 1, 2019 at 8:00 AM EDT
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CHARLOTTE, N.C. (Hannah Smoot/Charlotte Observer) - People who are Affordable Care Act participants in North Carolina could see a decrease in their insurance bills come January.

Blue Cross and Blue Shield of North Carolina, the only insurance company to provide Affordable Care Act coverage in all 100 N.C. counties, has requested an average ACA rate decrease of 5.2% for individuals.

The ACA rates have to be approved by the N.C. Department of Insurance, which Blue Cross N.C expects to happen in late August. The insurance company also requested a average rate decrease of 3.3% for small business ACA plans.

Open enrollment in ACA plans, also called Obamacare, begins on Nov. 1 and ends Dec. 15.

The total rate decreases would mean $238 million of savings in health care costs for customers in 2020, according to Blue Cross N.C.

The rate decrease is the statewide average. Actual premiums could change based on location, age, subsidy amount and plan, Blue Cross N.C. said.

The average ACA plan rate for N.C. customers is about $725 per individual member per month before federal subsidies, the company said. About 85% of N.C. members are eligible for the subsidies, and the average rate including subsidies is $140 per month.

The company isn’t releasing detailed information on regional pricing right now, but will release more information after getting approval from the Department of Insurance.

This rate decrease is the second that Blue Cross N.C. has requested in two years. The Observer reported that last year’s rate decrease request for 2019 ACA plans was the first such Blue Cross N.C. request since the ACA went into effect in 2014.

“What these rate reductions show is that... when the focus is on quality and accountability, costs go down and the customer wins,” Blue Cross NC President and CEO Patrick Conway said in a statement.

Blue Cross N.C. serves more than 435,000 individual ACA members and more than 8,5000 small businesses on ACA plans.

The insurance company said the rate decreases were made possible by reducing internal operating expenses, and shifting care to value-based provider reimbursement — paying for the value of services provided to patients, not the quantity.

Blue Cross N.C. launched a value-based care program, called Blue Premier, in January with five of the state’s health care systems: WakeMed Health & Hospitals, UNC Health Care Duke University Health System, Cone Health and Wake Forest Baptist Health, The (Raleigh) News & Observer reported in January.

That program shares patient medical bills with the participating health systems to prevent unnecessary or repeated procedures and exams. The program also lets health systems compare prices between the systems.

The company said the rate decrease request was also possible because the state legislature didn’t add regulatory burdens on the company.

The rate decrease requested for 2019 would have been larger, the company told the Observer in 2018, if the GOP tax reform legislation signed by President Donald Trump hadn’t repealed the ACA’s individual health insurance mandate.