It happened again this week, this time in West Virginia. A major for-profit health insurer, Coventry in this case, pulled out of that state's nascent health care marketplace, meaning Pittsburgh-based Highmark Inc.'s West Virginia branch will be the only insurer selling subsidized health policies on the exchange when it opens for business Oct. 1.
West Virginia's Coventry pullout was the latest in a series of similar announcements.
In the spring, UnitedHealth Group said it would offer plans in only a dozen state exchanges; previously it had said it would sell policies on as many as 25 exchanges. Cigna is offering plans in just five states, according to Kaiser Health News. Aetna has pulled out of at least five exchanges, after having originally proposed plans in 14 states, according to Kaiser.
The exchanges, a principal feature of the 2010 health care overhaul known as the Affordable Care Act, are meant to be online marketplaces where the uninsured can shop for a variety of policies from a variety of insurers. And while that will be the case in some states -- Pennsylvania, for example -- in others, the Blue Cross Blue Shield insurers are the only game in town.
"You'd have to ask the national for-profit insurers why they've pulled back," said Highmark CEO William Winkenwerder Jr. during a Wednesday telephone news conference.
"But they clearly [are] taking a very conservative approach ... standing back to see how it shakes out" before jumping in, Dr. Winkenwerder said.
That's because there could well be opening-month glitches.
This week, the contractors hooking up the "internal plumbing" of the exchanges said they will be ready to go by Oct. 1, by The Washington Post's account. But insurers still have concerns that if there are snafus and long wait times, it will be the insurers -- and not the tech vendors nor the exchange operators -- who get the blame from would-be customers.
"This is a huge undertaking" for the federal government, with "hundreds of moving parts," Dr. Winkenwerder said. "We hope things work smoothly. But this is not something we can count on."
Another concern, probably the larger one, is that the so-called young-and-healthies will be slow to buy insurance on the exchanges, and people with chronic health problems, who had previously been uninsurable, will flood the exchanges.
"We are taking a measured, multi-year approach to exchanges," said Walt Cherniak, spokesman for Coventry's parent company, Aetna, in an email to the Post-Gazette. "In 2014, we are focusing on the markets where we can be most competitive and deliver the greatest value to our customers."
Yet the Blues are diving in head-first, testing the waters ahead of some for-profit insurers.
For the Blues, the equation is partly about market share, but also about institutional history.
"We and others are participating because of our commitment to community," Dr. Winkenwerder said. "We've been subsidizing the uninsured for decades" and feel it's the right thing to do.
Highmark's landing site for exchange customers is www.discoverhighmark.com.nation - businessnews - health
Bill Toland: firstname.lastname@example.org or 412-263-2625.