Big changes are coming to the individual health insurance marketplace in Central Oregon.
PacificSource, Moda and Providence are all pulling out of the region, leaving just two options for people shopping for their own health insurance: BridgeSpan Health and Regence BlueCross BlueShield. Both carriers are raising their rates by roughly 20% next year.
Erik Wood is an enterprise market president at PacificSource. He joins us to share more about how insurance carriers make these decisions. We’ll also hear from Corrie Bridges, a broker at Bend Health Insurance, about what she’s hearing from clients as open enrollment approaches on Nov. 1.
Correction: This story has been updated to correct Corrie Bridges’ last name. OPB regrets the error.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Big changes are coming to the individual health insurance market in Oregon, and Central Oregon is being hit particularly hard. PacificSource, Moda, and Providence are all pulling out of the region, leaving just two options for people shopping for their own health insurance, BridgeSpan Health and Regence BlueCross BlueShield. But those insurers are both owned by the same nonprofit, and their rates are going up roughly 20% next year. In a few minutes, we’ll talk about all of this with a health insurance broker. First, I’m joined by Erik Wood. He is the enterprise market president at PacificSource. He joins us to talk about why they are pulling out of this individual market. Erik, great to have you on the show.
Erik Wood: Hi, Dave, I really appreciate the opportunity to be here with you today.
Miller: Before we talk about the decision that you all made, can you just remind us who the individual marketplace is for?
Wood: Sure. It’s an opportunity for individuals who otherwise do not have coverage through Medicaid, Medicare, or an employer-sponsored plan, the opportunity to buy individual policies on the exchange to support their annual coverage for that particular year.
Miller: What’s been happening to enrollment in the individual marketplace in the last year?
Wood: Essentially, the number of lives covered has dropped rather dramatically, and that’s in large part due to really three contributing factors. First of all, the decision by Congress to not renew the enhanced premium tax credits contributed to a pretty dramatic increase, which I think you mentioned earlier, the plans that are going to be in that market being up about 20%. That first step led to those increases. The second piece, a lot of individuals looked at health coverage, particularly the younger population, and chose to go without coverage. So that changes the dynamic of the risk pool. It makes the risk pools smaller because folks that were covered last year won’t be covered in 2027, and potentially less healthy, again, if it’s younger populations that choose to go without coverage.
The third thing is, that leads to volatility and uncertainty for carriers.
You mentioned the three carriers, us being one, that chose to exit the market as a byproduct of that reality. It just ultimately became too volatile and unsustainable for us and others, both regional and national carriers.
Miller: How much do you see what you’re talking about now as part of some kind of cyclical fluctuation, the down part of an up-and-down and up-and-down market, as opposed to something fundamentally different?
Wood: I’d say it’s fundamentally different. To me, you have a signal from Congress and the non-renewal of those tax credits that is a very intentional decision to not continue to support the current structures that provide coverage. If you look back, up until this point into 2026, you saw incremental increases in the folks that were covered on the ACA individual plans – again, year-over-year growth. That decision, with the non-renewal, started to trigger some dominoes that had an impact going forward. So I think it’s a pretty structural challenge to the overall program and the system in general.
Miller: I want to better understand what you were talking about when you were talking about the risk pool, and what you’re saying is that the people who were more likely to opt out of health insurance were in general, younger, healthier people; leaving older people, who might be bigger users of healthcare, leaving them in the pool. What does that mean if you’re an insurer?
Wood: Well, a couple things start to happen that make the risk greater for us as a carrier. You mentioned scale. So, the more membership that participate in the pool, on average, creates a broader scale, and creates, usually, less variation in the performance of that particular group or population. When you shrink that pool, that scale is challenged, and again introduces more variation for us as carriers.
The other thing, and you said it well, we see the demographics of the folks that tend to stay in and absorb those 20%-plus increases to be folks who really value and need healthcare and the coverage that it provides. They may be in the middle of a treatment plan, they may have some diagnosed clinical realities that lead to them wanting to continue to stay in regardless of pretty dramatic increases. That has real impact because, again, smaller, so more risk for variation, and on average, trending towards a less healthier population. It creates a dynamic of volatility for carriers that, I think, leads to some choosing to exit.
Miller: Right. Now I’m curious about the actual conversations that you all had before you announced this decision to pull out of this particular market, the individual market. I mean, what were the conversations like, internally?
Wood: These are really hard decisions. We’ve been providing individual coverage since the ACA started, so we’ve got a history of doing this work and we really value the folks that we cover in this particular segment. So it’s hard to make those decisions. We look at it though, and think about a couple things: one, we want to be proactive and thoughtful about where and when we can best serve members, and intentional about that activity. So again, a lot of planning and thought goes into that conversation.
The other thing I would say that really plays into the dialogue throughout the process is sustainability. We’re a 93-year-old nonprofit regional health plan. We want to continue to be here for another 93 years, and that volatility challenges our sustainability as a regional nonprofit health plan, and we have to make difficult decisions in light of that. But it’s a proactive, lengthy, engaged and informed conversation internally, to try to land in the right place for our organization and in support of our membership.
Miller: If I am hearing you correctly, all of the factors that you have identified so far, these are either specific federal policies, acts of Congress, say, or nationwide trends. But are there particulars in the region, in Central Oregon in particular?
Wood: No, it really is a national reality, and I think that’s demonstrated by some of the national carriers that chose to exit the ACA and individual coverage, as well as regional health plans like us. That decision, I would also note, for us, was across all three of our states, so that had an impact for Oregon, Idaho, and Montana. It wasn’t specific to a market or a county or rating region.
Miller: What does it mean for people who are still in this market when the majority of their options disappear?
Wood: I think that that’s the really hard part for the consumer. What are you left with? I think, as you mentioned earlier, a market that had five carriers last year for 2027 is gonna have two, so choice is limited. The network that supports the product, so the providers that are included could have changes or implications. The choice around which carrier you want to work with and why. The plan design, all of the options that you have shrink as a byproduct of less carriers, and quite honestly, design of product that changes as a byproduct of everyone trying to find a sustainable way forward.
Miller: What would it take for PacificSource to start offering insurance on this individual market again?
Wood: Good question. At the end of the day, we believe the health care system in this country works best when we have as many folks as possible covered. We believe in coverage, and if we can get to a place, both state and federal levels, that supports coverage, that’s what we believe in and what we advocate for. So I think that’s foundational.
The other pieces that become required to support the reassessment of this decision is really, again, I go back to sustainability for us financially. Can we continue to do it and do it well and serve our members and be the regional nonprofit carrier that we’ve been historically in that space? And then the ability to support affordability within the offering. It’s important that it works for us, but it’s also really important that it works for members and that we can provide a strong affordable product. I think all those variables would need to be in a more sustainable alignment for us to be able to be successful in that regard.
Miller: And just briefly, we’ve been talking about the individual market, but as I understand it, PacificSource is currently the only Medicare Advantage provider in Deschutes County and the only OHP Medicaid provider. How are those plans working right now, and do they feel, right now, more sustainable for you as a company than the individual marketplace?
Wood: I would say that the ACA in the individual marketplace is the most volatile right now for us. Just to be clear about that point. We’re the last remaining Medicare Advantage product and plan in Central Oregon, and we believe that Medicare Advantage is something that we can do and do well. We are really pleased with the relationships we have with all the membership in that market that we work proactively with, and the providers in that community as well.
On the Medicaid side of the house, we feel really good and excited about 2027 in that market as well. I think those are two particular lines of business that we feel are in a more sustainable and well-positioned spot to be able to support us as an organization and the members that we serve.
Miller: Erik, thanks very much.
Wood: Thank you. I really appreciate it.
Miller: Erik Wood is an enterprise market president at PacificSource. Corrie Booker [Editor’s Note: Host Dave Miller incorrectly said the guest’s last name. Her name is Corrie Bridges] joins us now. She’s a broker at Bend Health Insurance. Corrie, welcome to the show.
Corrie Bridges: Hi, thanks for having me.
Miller: Does it make sense to call the individual market in Central Oregon right now a true marketplace when there are only two options and they’re owned by the same nonprofit?
Bridges: That’s a good question. As Erik spoke a little bit, Oregon Health Insurance is going through one of its biggest shakeups in years, and Central Oregon is feeling it more than anywhere, I would say. It’s tied to the fewest choices in the state, and so everything’s changing at once. People are dealing with carrier exits, a brand new state-run marketplace, and new OHP work requirements, all in the same season.
Miller: What do you think that this is gonna mean, specifically, for people who want or feel like they need to have health insurance and can only get it through the individual market? They don’t qualify for Medicare or Medicaid and they don’t get insurance through their employer?
Bridges: Erik touched on it, I think a lot of people are going to just not have coverage, because of the price. From the clients that I’ve spoken with, they’re confused and feeling overwhelmed, and many people are getting termination notices from PacificSource or Providence; and the marketplace has said that choosing health insurance can feel overwhelming and it’s definitely that, and there’s also the sticker shock where a 20% increase really hits households hard. So I think a lot of people will probably opt out of coverage because of that, just because of the price, which doesn’t help carriers, it doesn’t encourage carriers to stay in our state.
Miller: And it doesn’t help you if you then get a catastrophically large bill because you have a heart attack or get cancer.
Bridges: Right.
Miller: More broadly, what does this mean, then, for the health of the region when coverage options shrink like this and fewer people have insurance?
Bridges: When choices go away, it’s not just about fewer carriers to pick from. It means higher prices, less competition, more people skipping care until it becomes an emergency, and then it ends up costing the whole community, not just the people buying their own insurance. What happens is, uninsured people get sick and then end up in the emergency room, and then those bills go unpaid. Hospitals make up the difference by charging more elsewhere, which pushes costs up for everyone, including people with insurance through work.
And it really hits small businesses and the self-employed people hardest. Central Oregon has a lot of small business owners and contractors and people who work for themselves, and they’re the ones buying their own insurance, and they’re going to feel this the most.
Miller: I’m glad you talked about the region in particular, because, as Erik was saying, a lot of this is national trends and Congressional changes, but what do you see as the aspects of the story that are particular to Central Oregon or other areas of Oregon in particular?
Bridges: As I mentioned earlier, Providence and PacificSource have left that individual market. Moda is pulling out of eight counties, including Deschutes and Crook. Deschutes County will only have two carriers on the individual market next year, which are Regence and BridgeSpan, and those are both owned by Cambia. So in practice, there’s no real competition there on price or anything.
And then on the Oregon Health Plan, PacificSource is the only provider there, and for seniors, you guys mentioned this earlier, that Medicare Advantage carrier, the only carrier is PacificSource. So whether you buy your own coverage or you’re on OHP or Medicare, you’re effectively down to one company. We really don’t have any option here in Central Oregon for coverage, which is not ideal.
Miller: When someone comes to you and says, “I feel like I really should have health insurance and I’m not sure if I can afford it right now,” what do you say?
Bridges: Well, it’s obviously a personal decision, and the biggest issue is if there is some sort of catastrophic event: cancer, stroke, heart attack, those are kind of the big three. And if you were to get into a situation where you had one of those issues happen to you, you could have to file for bankruptcy if you don’t have the funds to cover a situation like that. So, it does leave you very vulnerable to not have any coverage.
Miller: You mentioned that Oregon recently launched its own website for the individual marketplace years ago, at the beginning of the Affordable Care Act, when states could set up their own marketplaces. Oregon tried, it was a spectacular and unbelievably expensive failure and then they went with the feds. How is this new site working?
Bridges: That’s a good question. It’s a new site for me. I’m still learning it along with all the other brokers in Oregon. You know, previously this was managed federally on healthcare.gov, and now it will be managed by the state again. As far as I know, it just launched on October first. We’re all getting access to the platform and registering on ExploreHealthOR.gov which is the new site, and I’m skeptical of a state-run program, but we’ll see if the kinks can get ironed out and it can work properly. The sign up window is shorter this year for the individual, it’s November 1 through December 31, so I would say just don’t wait until the last minute this time around.
Miller: Also open enrollment starts very soon. What other insurance changes are you keeping an eye on right now, and what else do you think folks should be paying attention to, whether it’s the individual market or other coming changes to health insurance?
Bridges: It’s hard to know what the future holds. Obviously, being in Central Oregon and having one hospital and very few carriers to choose from and not feeling like we have a choice here feels very vulnerable and I think there’s a lot of question marks around that. We have seen it across all different types of health insurance.
I mentioned OHP and Medicare, and I think especially for those individuals, the seniors that are on Medicare, because those are highly vulnerable people in our society, and they’ve paid into Medicare their whole career. I would say that those people that are on Medicare are really the group of people that are really feeling it the most as far as feeling that vulnerability. So we’ll see. It’s hard to know what’s going to be coming down the pipeline here in the next couple of years in Oregon.
Miller: Corrie, thanks very much.
Bridges: Thank you.
Miller: Corrie Bridges is an insurance broker at Bend Health Insurance.
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