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Health plan sick list: South Carolina, Wyoming, Kentucky, Illinois

By Allison Bell

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The third Patient Protection and Affordable Care Act (PPACA) open enrollment period is about to start Nov. 1, and the trickle of news about financial worries at health insurance carriers has turned into a steady flow of bad, and not-so-great news.

Consumers’ Choice Health Insurance Company, the Consumer Operated and Oriented Plan (CO-OP) carrier in South Carolina, has been the latest CO-OP to announce that it will shut its doors at the end of the year.

South Carolina’s PPACA CO-OP now has about 67,000 enrollees.

Like several other PPACA CO-OPs that have announced run-off plans in recent weeks, Consumers’ Choice has put out a statement saying that the funding shortfall at the PPACA risk corridors program has forced it out of business.

See also: Feds: PPACA risk program may pay just 13% of 2014 claims

Ray Farmer, the South Carolina insurance director, said the South Carolina Department of Insurance will do everything it can to help state residents through the CO-OP shutdown process.

“Our expectation is that the company will honor its existing commitments to policyholders and health care providers as a part of winding down its operations,” Farmer said in a statement.

Consumer’s Choice is separate from South Carolina Health Cooperative, a nonprofit, member-owned group health cooperative formed outside the PPACA CO-OP program. South Carolina Health Cooperative failed at the end of 2014.

In other health carrier financial worries news:

• The Wyoming Department of Insurance said it is going to court to try to put a struggling health insurer there, WINhealth, into receivership.

The insurer had already announced plans to wind down its operations. Tom Glause, the Wyoming insurance commissioner, alleges in a petition filed Wednesday in a state court in Wyoming that WINHealth needed to have $6.5 million in surplus as of June 30 but ended June with only $3.3 million in surplus.

WINHealth lost $2.5 million during the first half of 2015, and its June 30 surplus total included $4.6 million in cash that was supposed to be coming from the PPACA risk corridors program.

The Centers for Medicare & Medicaid Services (CMS) told WINhealth on Oct. 2 that the program will pay 12.6 percent of the risk corridors program balance to WINhealth “later this year,” and that “there were not any additional funds available to pay the remaining risk corridor balance,” according to an affidavit by Joseph Holloway Jr., a financial examiner, included with the petition.

“WINhelath’s internal cash flow projections show that it will run out of cash in November of 2015,” according to the affidavit.

• Managers of Kentucky’s CO-OP, Kentucky Health Cooperative, gave a little more information about that carrier’s decision to shut down in a “Dear Member” message posted on the company’s main website. The managers acknowledged that they said nothing in 2016 coverage renewal letters about going out of business. “True,” the managers say in the message. “And there’s only one reason that a winding down of our operations at the end of this year was not mentioned. We did not know.“

Mangers say they believed that the company was on track to have a strong financial position in 2016.

“Funding on which we had depended upon did not come through,” the managers say, in what appears to be an indirect reference to the PPACA risk corridors program funding shortfall.

• Health Care Service Corp. (HCSC), the parent of the Blue Cross and Blue Shield plans in Illinois and Texas, continues to be one of the biggest, strongest organizations in the health insurance market. But analysts at Fitch Ratings have switched the outlook on HCSC’s A plus insurer financial strength rating to negative, from neutral.

HCSC reported $282 million in net losses for 2014, and $434 million in net losses for the first half of 2015.

HCSC controls a number of Blue Cross and Blue Shield plans outside of Illinois and Texas, and it’s the parent of Dearborn National, a benefits provider, but it gets much of its revenue from the Illinois and Texas health insurance markets.

Fitch attributed the change in the carrier’s rating outlook mainly to the recent losses and the high concentration of business in Illinois and Texas.

Mark Rouck, a Fitch analyst, said the risk corridors program funding shortfall has only a modest effect on his company’s views of HCSC. HCSC could have trouble collecting on its $115 million risk corridors program receivable, but HCSC should still be able to get $1.2 billion in PPACA reinsurance money, Rouck said.

“That’s a much more meaningful number,” Rouck said.

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