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Health Care Reform:

Health Insurance & Affordable Care Act

Lack of Competition, High Rates in Alabama

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Even so, better state regulation and more insurers bidding for business could have saved Alabamians substantial money, said Jim Carnes, policy director for the Alabama Arise, which works to improve life for low-income Alabamians. 

If Gov. Robert Bentley spent as much energy recruiting insurers to compete against BlueCross as he does wooing industry and entrepreneurs, he could lower prices under the federal health law and boost access to care, he said.

"But instead he chose to remain passive," said Carnes. "And as a result we have the lowest level of competition on the country."

BlueCross Responds

BlueCross spokeswoman Koko Mackin said that the company offers "high quality coverage at some of the lowest premiums in the country" and that "our customers' faith in us has provided us our market share."

BlueCross Alabama had about 150,000 subscribers in 2011 purchasing plans directly instead of obtaining coverage through employers. The health law was expected to cut the state’s uninsured population of 700,000 by more than half, partly through expanding the Medicaid program for the poor and partly by selling subsidized commercial coverage through the exchange.

But Bentley, a retired dermatologist, rejected the Medicaid expansion after the Supreme Court allowed states to opt out.

Alabama also is one of a half-dozen states refusing to enforce the health law. Now enrollment advocates worry BlueCross's higher prices will prompt more Alabamians to choose to pay the health law's penalty for lacking coverage rather than buy a plan.

Bentley, who in September said the best approach to the law is to "sit back and watch it crumble," did not respond to an interview request made through a spokeswoman.

Proponents say what's going on in Alabama demonstrates the risks in reform that depends on state cooperation and insurer competition. David Marcus, 51, whose BlueCross family premium is set to rise by half to $1,033 a month, says it shows basic flaws in the law. (He said he doesn't know if he's eligible for subsidies.)

"I don't think they're ever going to get it implemented completely," he said. "It's too confusing for too many people."

Jordan Rau contributed.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Fri, Nov 1 2013

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