Despite challenges faced by other states, Virginia's marketplace — the health insurance program set up under the Affordable Care Act — remains robust in regards to the number of options and insurance providers available.
Virginia has eight insurers participating in tiered coverage for people looking for health insurance in the marketplace, according to the latest ACA filings with the Virginia Insurance Commission.
"Virginia has done well compared to other states," said Doug Gray, executive director of the Virginia Association of Health Plans. The association promotes a legislative and regulatory agenda for operating health plans statewide. "It has been successful in helping people with modest incomes have access to and be able to get health insurance."
Factors working in Virginia's favor include higher enrollment by young, healthy people — a demographic coveted by insurers to help offset costs for older, sicker people, said Cynthia Cox, a Kaiser Family Foundation researcher who studies economics and the policy of health insurance markets and reforms. Virginia also is a large state with several metropolitan areas that are attractive to insurers, Cox said.
"Virginia's marketplace has done better than other states," Cox said. "It's been more successful at attracting and keeping insurers." Areas in Virginia with fewer insurers still have options — participants may choose from several plans under one insurance provider, she added.
The number of insurers providing plans in Virginia's marketplace has fluctuated. It added providers in 2014, 2015 and 2016, data from the state insurance commission show. It lost a major insurance provider, Aetna, this May.
In a May 3 statement, Aetna said based on growing uncertainty in the marketplace, "we will not offer on- or off-exchange individual plans in Virginia for 2018." The insurer also pulled out of Ohio's exchange, leaving some counties there with no marketplace insurer.
Aetna sold health plans in 50 of Virginia's 95 counties, according to the Robert Wood Johnson Foundation. The exit leaves one insurer, Anthem, and its plans in counties where Aetna operated marketplace plans, the foundation reported.
Insurers providing marketplace plans include Optima Health, which is owned by Sentara Healthcare, a large provider of health services in Hampton Roads, and a few Anthem providers, another familiar insurance company to the region. The individual market makes up a small piece of the state's insurance pie — many Virginians are covered by employer-sponsored health insurance plans.
Those purchasing health insurance through the marketplace pay a percentage of their income for coverage. Depending on how they fit into federal poverty guidelines, people can receive a tax credit or subsidies to help pay premiums.
"Eighty-three percent of people on the exchange get a subsidy from the government because they make so little money," Gray said of Virginia's marketplace. "These are working people — some with more than one job — who really need subsidies to be able to afford health care."
During the most recent open enrollment period, more than 360,000 Virginians signed up for health insurance under the ACA. Roughly 1 million people are covered by Medicaid, and a similar amount of people 65 and older are covered by Medicare and its programs in Virginia.
A GOP-led Congress and President Donald Trump have said Obamacare is failing, and they point to double-digit premium increases and big insurers leaving some state exchanges. The Senate proposed a bill, the Better Care Reconciliation Act, to make major changes to the health care law established in 2010, but it does not repeal the law's major components.
Some national health experts dispute claims that the ACA markets are failing. The Kaiser foundation released a study Monday showing ACA markets across the country are stabilizing.
"Early results from 2017 suggest the individual market is stabilizing and insurers in this market are regaining profitability," the study reports. "Insurer financial results show no sign of a market collapse."
In Virginia, premium increases and the loss of Aetna haven't deterred people from signing up for health insurance or led to instability in the markets, Cox said.
Other states with a number of insurers in ACA health insurance programs include Wisconsin, which is the state with the most insurers at 15; New York, which has 14; California, 11; and Ohio and Texas each with 10 companies offering tiered plans and coverage.
The five states at the bottom of the list — Alaska, Alabama, Oklahoma, Wyoming and South Carolina — all have one insurer offering tiered plans and coverage, according to Kaiser foundation data.
Canty can be reached by phone at 757-247-4832.