Molina Healthcare to withdraw from Wisconsin ACA exchange

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Molina Healthcare Inc. announced Wednesday it is exiting the Affordable Care Act marketplace in Wisconsin next year.

Molina’s decision follows Anthem Blue Cross and Blue Shield’s announcement last month that it is dropping individual coverage in Wisconsin next year, citing the volatile and unpredictable individual market since the Affordable Care Act was enacted. Louisville, Kentucky-based Humana Inc. discontinued its individual major medical insurance plans in Wisconsin in 2017.


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Molina Healthcare, based in Long Beach, California, announced its plans to drop out of the Wisconsin and Utah marketplaces on Wednesday as it reported a second quarter net loss of $230 million. 

“We are disappointed with our bottom-line results for this quarter and have taken aggressive and urgent steps to substantially improve our financial performance going forward,” said Joseph White, chief financial officer and interim president and CEO, in a statement.

The company said it will continue to review its marketplace participation in other state exchanges.

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“Based upon revenue and cost trends observed in the second quarter of 2017, we now believe that Marketplace performance in the second half of 2017 will fall substantially short of previous expectations,” the company said in a press release. “Marketplace performance has been most disappointing in Florida, Utah, Washington, and Wisconsin.”

The company plans to increase premiums by 55 percent next year in its remaining marketplace plans.

The remaining insurers on the exchange in Milwaukee County next year include Brookfield-based Common Ground Healthcare Cooperative, which has 29,000 members; Children’s Community Health Plan, which has 3,000 members; and Network Health Plan, which has 8,800 members.

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Insurers have until September to decide whether they will participate in the exchange in 2018.

Jim Mueller, president and CEO of Waukesha-based health benefits consulting firm Mueller QAAS LLC, said Molina’s decision will have far-ranging implications for the remaining insurers in the region.

“This affects people three ways: the number of options available as far as insurers; the number of providers — Molina had the greatest number of providers available — and greater uncertainty,” Mueller said. “This is a slippery slide because now the others have to decide what they’re going to do now that Molina is going to dump their market share, which is a huge market share, and everyone knows that it’s unprofitable.”

During a discussion about health care reform in June, Bob Duncan, executive vice president of community services for Children’s Hospital of Wisconsin, said the Children’s Community Health Plan intended to stay in the marketplace next year.

Common Ground Healthcare Cooperative is one of only four healthcare co-ops nationwide still in business from the original 23 that launched in 2014 under the Affordable Care Act.

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