After years of turmoil, less drama so far for Minnesota insurance market

Ryan Walseth has been frustrated for a few years now by recurring jumps in his health insurance costs.

The self-employed personal trainer has done his best to tame rate hikes by taking bigger deductibles and switching health plans to find the best deal.

But now, with insurers in the Twin Cities proposing relatively modest premium bumps next year, Walseth might not have to sweat his choice of a 2018 plan.

"The last thing I want to do is shop for health insurance," said Walseth, 38, of Minneapolis. "I'd be more than willing to just stay with my health plan, so I can keep my doctor, know where to park at the clinic, not have to deal with new forms — just avoid all the hassle."

After three years of volatility, Minnesota's market for people who buy their own health insurance is finally looking healthier, with smaller proposed premium increases and a stable lineup of companies offering coverage.

Things aren't perfect, to be sure, and many key details aren't yet known. Final rates aren't out yet, with the release expected by Oct 2. Consumers still wonder about the limits they will face in their choice of doctors and hospitals. And it's not clear if moderate price increases in the Twin Cities will contrast with painful hikes in outstate Minnesota.

But at this point, there aren't nearly as many distress signals as last year.

After the biggest carrier in the individual market announced last summer that it would shut down its most popular health plans, regulators granted across-the-board average rate hikes of at least 50 percent for 2017 plus coverage and enrollment limits that vexed consumers. Enrollment shrank by 30 percent. Lawmakers scrambled to stem the bleeding with hundreds of millions of additional dollars, including premium rebates for 2017 and a proposed reinsurance program to hold down rates next year.

"It looks like it's stable, but that stability was achieved at a price," said Roger Feldman, a health policy expert at the ­University of Minnesota.

The twists and turns are confined to the state's individual market, which primarily serves people under age 65 who either are self-employed or don't get health insurance from their employer.

It's a small market that serves less than 5 percent of the state's population. But the market has been the focus of intense public scrutiny due to changes brought by the federal Affordable Care Act.

The ACA in 2014 eliminated pre-existing condition exclusions in the individual market that frustrated consumers by letting insurance companies avoid the patients most likely to use pricey care. The health law also pumped big federal subsidies into the market by way of tax credits for people who buy through new health insurance exchanges like Minnesota's MNsure.

Many insurers that originally saw a growth opportunity with the ACA have instead recoiled from the market, with red ink prompting companies to boost rates, scale back offerings or drop out entirely. The exits have raised concerns that the markets might collapse — something that regulators say nearly happened last year in Minnesota.

It's against that backdrop that this summer's numbers look pretty good.

In late July, the Minnesota Department of Commerce released data showing that health insurers are proposing average rate increases for 2018 that range from 3 percent to 32 percent. While the range remains greater than inflation and includes some double-digit increases, the two carriers with individual products focused on the Twin Cities kept proposed average jumps in the single digits.

In August, the Kaiser Family Foundation reported that the proposed premium for a 40-year-old buying the "benchmark" silver plan via MNsure would increase by 5 percent in the Twin Cities region. More than half of all individual market shoppers buying through MNsure live in the area.

By mid-August, regulators released second quarter filings that show individual market premiums for Minnesota health plans exceeded claims by $154 million through the first six months, according to a Star Tribune analysis. That's better than each of the last three years, when full-year premiums in the individual market didn't cover the cost of medical claims — let alone insurance company overhead costs — and drove financial losses.

"What we saw heading into 2017 was really some seismic rate increases," said Geoff Bartsh, a vice president at Minnetonka-based Medica. "It was, essentially, a market catch-up to where it looks like [the premiums] needed to be."

Insurers say it's still too early to conclude the state's individual market is stable.

Health plans typically field more medical claims in the second half of the year, because those with deductibles wind up covering many medical bills out-of-pocket during the first six months. So, the ratio of premium revenue to medical expenses for insurers typically gets worse as the year goes on.

Insurers worry the Trump administration won't enforce the health law's mandate for individuals to have health insurance or pay a tax penalty. In addition, Trump hasn't made a long-term commitment to fund "cost-sharing reduction" payments that help low-income people afford individual coverage.

"Until we have stability in Washington, D.C., we can't expect to have stability in Minnesota," said Jim Schowalter, chief executive of the Minnesota Council of Health Plans, a trade group for insurers.

A Star Tribune analysis of insurance company financial results released earlier this month fits with the broader trend of individual markets across the country doing better this year than in 2016, said Deep Banerjee, a director with S&P Global Insurance Ratings. Even so, he said the market is still maturing.

"We wouldn't jump to conclude that this is a clean bill of health," he said in a statement. "This shows improvement, but not stability."

Consumers say smaller premium increases would be welcomed, but that rates have been just part of the problem.

Thanks to the ACA's promise of coverage despite pre-existing conditions, Karen Laumb, 42, of Golden Valley, left a job with good benefits a few years ago to start her own business. Over the last several years, she's been troubled not just by premium increases for her individual market policy but also the tight limits on her choice of doctors and hospitals.

As a cancer survivor, Laumb has made it a priority to pick a health plan that provides in-network access to her endocrinologist. For 2017, however, she found there was no way to buy an individual market policy that included in its network the endocrinologist and four other health care providers she's visited regularly for years.

Visiting providers on an out-of-network basis typically brings much higher out-of-pocket costs. So at the end of last year, Laumb went on a "farewell tour" of doctors and others she knew she'd be leaving. This past week, she was dismayed to learn that her health plan's choice of in-network hospitals will get even tighter in September.

"Health care is important and deeply personal," Laumb said. "Those relationships with doctors — the trust and shared partnership you build up over the years — I feel like the importance of that has gotten lost in the individual market."

Christopher Snowbeck • 612-673-4744

Twitter: @chrissnowbeck