Whenever I write or talk about the 3-Legged Stool of the ACA and the actual flaws in the law (as opposed to the ones deliberately created by the GOP), I usually focus on two "gaps" in the legs: The APTC subsidies getting cut off at 400% FPL and being too stingy below that level, and the individual mandate not being large enough (and not being properly enforced). As it happens, part of the first problem has already been unintentionally "solved" thanks to Trump's ham-handed CSR reimbursement cut-off (which ended up increasing APTC tax credits for those below the 400% cut-off), while the second problem has just been made a whole lot worse thanks ot the GOP repealing the mandate altogether.
According to Steve Valandra, spokesperson for the Washington State Office of the Insurance Commissioner, the department has already come to a "done deal" agreement with Centene/Ambetter, the terms of which include:
The cease & desist order will be removed immediately, allowing Centene/Ambetter to continue selling plans on the individual market in Washington (including the ACA exchange)
Centene/Ambetter will immediately ameliorate all patient billing errors and other issues
Centene/Ambetter will be hit with a $1.5 million fine, but $1 million of this will be suspended if there are no further violations for at least 2 years
Centene/Ambetter must hire an external auditor, approved by the state insurance dept., to go over their books/etc.
The official notice of this agreement will be posted publicly on the Insurance Commissioner's website within 5 days.
A few months ago I noted that while UnitedHealthcare and some other carriers may be losing money hand over fist on the ACA exchanges, at least some of them are making a profit, breaking even or at least cutting their losses down to a reasonable level.
As a simple reminder, competitive markets should see some companies make money and some companies that offer more expensive and less attractive products lose money. I would be extremely worried if everyone was making money after three years, just like I would be extremely worried that everyone was losing money after three years of increasingly better data.
U.S. health insurers Aetna Inc and Anthem Inc on Friday sought to reassure investors that their Obamacare businesses had not worsened after UnitedHealth Group Inc warned of mounting losses in that sector.
Aetna and Anthem said their individual insurance businesses, which include the plans created by President Barack Obama's national healthcare reform law, had performed in line with projections through October. Both backed their earnings forecasts for 2015.