LEWISTON — Maine’s only health insurance co-op lost $4.5 million in November, more than double for what it had planned.
However, its president says Lewiston-based Community Health Options is doing better than it was a year ago.
“Despite the difficulties we’ve gone through, we’re frankly a stronger company as a result,” CEO Kevin Lewis said.
He said the co-op is in a better financial position going into 2017 than it was going into 2016 and it has sufficient capital and enough surplus to accommodate members.
“We anticipate, given the adequacy in rates that we have for 2017, that we’ll continue to build upon our surplus,” he said.
In its monthly statement on the co-op, the Maine Bureau of Insurance this week noted:
* Membership was 5.6 percent lower than expected in November.
* Premiums — the amount people pay for insurance — were 6.4 percent lower than planned for the month.
* The co-op used the last of the $43 million it had put in reserve for 2016, draining the account a month sooner than planned.
* Its cash, bonds and short-term investments were 26.6 percent lower than expected and were almost 12 percent lower in November than October.
But the bureau noted that claims — medical bills the co-op has to pay for — were 8 percent lower than expected and expenses were 8.3 percent lower than planned. Both were spots of financial good news.
“As with other insurers, December results will have a significant impact on results for the entire year,” the bureau said in its statement. “The (Bureau of Insurance) is therefore closely following (Community Health Options’) operating results as it also works with the company to refine and finalize the 2017 plan.”
Co-ops are health insurance companies run by members for members, like credit unions. They were created through the 2010 federal Affordable Care Act to increase competition among health insurers and to provide consumers with greater choice in the marketplace.
Community Health Options began selling plans in 2013 and quickly rocketed to the top of Maine’s individual health insurance market, attracting members with its low premiums, broad network of doctors and hospitals and unique program benefits.
At one point, it was the only profitable co-op in the country. That changed in 2015 when its insurance claims were higher than expected and it began losing money.
The Maine Bureau of Insurance has been closely monitoring the co-op since early 2016.
To try to regain its financial footing, the co-op cut administrative expenses, temporarily suspended sales of new individual insurance plans and pulled out of New Hampshire.
Last summer, it filed suit against the federal government, claiming it was owed nearly $23 million.
Community Health Options has about 51,000 members, roughly half of whom bought plans through the federal marketplace.
If that federal marketplace gets dismantled as part of the Republican plan to repeal the Affordable Care Act, it is unclear how the co-op would be affected.
“Everyone I’ve heard has been indicating there’s going to be some replacement (of the ACA),” Lewis said. “The question is: What are the details for those replacement plans and how is that going to support individuals and businesses that have benefited from coverage?”
Although President-elect Donald Trump and many Republican lawmakers are set on quickly repealing the Affordable Care Act, it currently remains law. Open enrollment for health insurance runs through Jan. 31.
According to the federal government, just over 77,300 Mainers signed up for health insurance through the federal marketplace as of Dec. 24 and got federal subsidies to help pay for that insurance that averaged $347 a month.
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