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State officials take control of Portland insurer Moda Health

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Regulators taking steps to curb consumers' exposure to Moda Health's poor finances.


State officials are moving in to take partial control of Portland-based health insurer Moda Health, citing financial struggles and risk to consumers.

Moda's finances have gotten so bad that officials will block the firm from selling or renewing policies and are moving to shift about 67,000 members to other insurers. The company has seven days to raise capital or it could face further restrictions.

The move marks a dramatic reversal for the once-dominant firm, whose name adorns the Portland Trail Blazers arena and one of downtown Portland’s taller buildings. It comes with only days left before a key enrollment deadline for people who purchase their own insurance and are not on Medicare.

“We are encouraging people to sign up with someone other than Moda in these final days of open enrollment,” says Oregon Insurance Commissioner Laura Cali.

Cali and Patrick Allen, the state’s consumer and business services director, say they are taking additional steps to protect consumers. For now, the company won’t be allowed to sell or renew business coverage, though that could change. The firm will submit a plan to right its financial ship by end of day Friday, after which the state will determine whether it can resume selling and renewing policies for businesses.

Moda spokesman Jonathan Nicholas issued a statement saying the firm had resolved to "exit" the individual market for consumers who buy their own policies but are not on Medicare. It linked the company's struggles to the Affordable Care Act, which resulted in an influx of people with medical conditions who'd previously been uninsured.

“Bringing tens of thousands of people into the ACA marketplace, many of them with acute healthcare needs, has been a difficult process to manage,” according to a statement attributed to Robert Gootee, CEO of the parent company of Moda Health, Moda, Inc.

A state financial examiner has been stationed at Moda headquarters since Wednesday, and no significant financial transactions will be allowed without advance approval. Alaska, where the firm also does business, is expected to take similar steps.

Rumors have swirled for months about Moda's financial condition. The firm last year received a $50 million loan from Oregon Health & Science University as well as one of the same amount from its parent company.

Then, on Monday night, Cali received word from a top Alaska insurance regulator that the firm's condition had deteriorated further. By Wednesday evening she'd issued an "order of immediate supervision" that authorized the state's move. It said Moda's finances are "in such condition that its continuation of business with financial results currently reported is hazardous to the public or to its insureds."

Officials are arranging a special enrollment period for the roughly 67,000 Oregonians who’ve signed up with Moda in the current individual market enrolment period, which ends Jan. 31. They’ll be asked to select a different insurer instead.

Allen expects minimal impacts for Moda members who are enrolled in group insurance – roughly 145,000 Oregonians as of last fall. Nor will there be immediate impact on 43,000 teachers and state employees enrolled through Moda, or the 48,000 members served by a Medicaid managed care company in Eastern Oregon that Moda partly owns, according to the state.

“We're going to be working with the company to make sure they pay claims,” Cali says.

The state's legal order gives the company seven days to raise funds to boost its capital reserves to an acceptable level.

Moda took a major hit last year when about $90 million in financial assistance expected from the federal government for 2014 did not materialize. Though most Oregon insurers had booked only a fraction of the funds as likely to be forthcoming, Moda booked 100 percent of the funds, an approach that allowed it to justify lower rates. The company later raised its 2016 rates by an average 25 percent in the individual market, and some agents felt the firm was doing everything it could to shed members and reduce exposure to costly medical claims.

In November, Oregon Health & Science University reached a potential deal to convert its loan into a 25-percent stake in Moda. In a statement, the university expressed concern but did not directly address whether it planned to follow through or expand its involvement to address Moda's need for capital. The OHSU board is meeting today.

"While the news of Moda’s fourth quarter performance is disappointing, OHSU remains committed to its vision of building an Oregon-based health care system that will include partnerships with hospitals, provider groups and payers," said the statement.

This article will be updated and expanded later today