Modest premium hikes as ‘Obamacare’ stabilizes
Millions of people covered under the Affordable Care Act will see only modest premium increases next year, and some will get price cuts. That’s the conclusion from an exclusive analysis of the besieged but resilient program, which still sparks deep divisions heading into this year’s midterm elections. The Associated Press and the consulting firm Avalere Health crunched available state data and found that “Obamacare’s” health insurance marketplaces seem to be stabilizing after two years of sharp premium hikes. And the exodus of insurers from the program has halted, even reversed somewhat, with more consumer choices for 2019. The analysis found a 3.6 percent average increase in proposed or approved premiums across 47 states and Washington, D.C., for next year. This year the average increase nationally was about 30 percent. The average total premium for an individual covered under the health law is now close to $600 a month before subsidies. For next year, premiums are expected either to drop or increase by less than 10 percent in 41 states with about 9 million customers. Eleven of those states are expected to see a drop in average premiums. In six other states, plus Washington, D.C., premiums are projected to rise between 10 percent and 18 percent. Insurers also are starting to come back. Nineteen states will either see new insurers enter or current ones expand into more areas. There are no bare counties lacking a willing insurer. Even so, Chris Sloan, an Avalere director, says, “This is still a market that’s unaffordable for many people who aren’t eligible for subsidies.” Nearly 9 in 10 ACA customers get government subsidies based on income, shielding most from premium increases. But people with higher incomes, who don’t qualify for financial aid, have dropped out in droves. It’s too early to say if the ACA’s turnabout will be fleeting or a more permanent shift. Either way, next year’s numbers are at odds with the political rhetoric around the ACA, still heated even after President Donald Trump and congressional Republicans failed to repeal the law last year. Trump regularly calls “Obamacare” a “disaster” and time again has declared it “dead.” The GOP tax-cut bill repealed the ACA requirement that Americans have health insurance or risk fines, effective next year. But other key elements remain, including subsidies and protection for people with pre-existing conditions. Democrats, meanwhile, accuse Trump of “sabotage,” driving up premiums and threatening coverage. The moderating market trend “takes the issue away from Republican candidates” in the midterm elections, said Mark Hall, a health law and policy expert at Wake Forest University in North Carolina. “Part of the mess is now their fault, and the facts really don’t support the narrative that things are getting worse.” Market stability also appears to undercut Democrats’ charge that Trump is undermining the program. But Democrats disagree, saying the ACA is in danger while Republicans control Washington, and that premiums would have been even lower but for the administration’s hostility. “Voters won’t think that the Trump threat to the ACA has passed at all, unless Democrats get at least the House in 2018,” said Bill Carrick, a strategist for Sen. Dianne Feinstein, D-Calif., whose re-election ads emphasize her support for the health law. As if seconding Democrats’ argument, the Trump administration has said it won’t defend the ACA’s protections for pre-existing conditions in a federal case in Texas that could go to the Supreme Court. A new Kaiser Family Foundation poll found that Americans regardless of partisan identification said those protections should remain the law of the land. In solidly Republican Arkansas, Democratic state legislator and cancer survivor Clarke Tucker is using the ACA in his campaign to try to flip a U.S. House seat from red to blue. Tucker, 37, says part of what made him want to run is the House vote to repeal the ACA last year and images of Trump and GOP lawmakers celebrating at the White House. Business analysts say the relatively good news for 2019 is partly the result of previous premium increases, which allowed insurers to return to profitability after losing hundreds of millions of dollars. “They can price better, and they can manage this population better, which is why they can actually make some money,” said Deep Banerjee of Standard & Poor’s. Repeal of the ACA’s requirement to carry insurance doesn’t seem to have had a major impact yet, but Banerjee said there’s “a cloud of uncertainty” around the Trump administration’s potential policy shifts. Yet some administration actions have also helped settle the markets, such as continuing a premium stabilization program. April Box of Spokane Valley, Washington, lives in a state where premiums could rise substantially since insurers have proposed an 18 percent increase. In states expecting double-digit increases, the reasons reflect local market conditions. Proposed increases may ultimately get revised downward. Box is self-employed as a personal advocate helping patients navigate the health care system. She has an ACA plan, but even with a subsidy her premiums are expensive and a high deductible means she’s essentially covered only for catastrophic illness. “I’m choosing not to go to the doctor, and I’m saying to myself I’m not sick enough to go to the doctors,” Box said. “We need to figure out how to make it better and lower the price.” Now in her 50s, Box was born with dislocated hips. She worries she could be uninsurable if insurers are allowed to go back to denying coverage for pre-existing conditions. She might need another hip surgery. “It needs to be a level playing field for everybody,” said Box. “We need to have universal coverage — that is really the only answer.” Tennessee is a prime example of the ACA’s flipped fortunes. Last year, the state struggled to secure at least one insurer in every county. But approved rates for 2019 reflect an 11 percent average decrease. Two new insurers — Bright Health and Celtic— have entered its marketplace, and two others —Cigna and Oscar— will expand into new counties. Tennessee Republican
U.S. clings to health coverage gains despite political drama
Americans kept up their health insurance last year despite President Donald Trump’s all-out push to dismantle the Obama-era coverage expansion. That’s the counter-intuitive conclusion from a major government survey Tuesday. After nearly a full year of Trump, the uninsured rate was 9.1 percent for 2017, almost the same as toward the end of the Obama administration, according the Centers for Disease Control and Prevention. That works out to a little more than 29 million people uninsured. Overall, the uninsured rate has dropped from 16 percent when the Affordable Care Act was signed in 2010, which translates roughly to 19 million people gaining coverage. “Despite all the noise and despite the chain-rattling Republicans have done with their failed attempts at repeal, at the end of the day the number of uninsured has stayed flat,” said health economist Gail Wilensky, a longtime GOP adviser. “That’s good news for the country, and it might turn out to be good news for Republicans when it comes time for the midterm elections.” But the CDC’s National Health Interview Survey also showed uninsured numbers edged higher for some groups, raising questions about potential problems this year and beyond. It doesn’t reflect congressional repeal of the health law’s unpopular requirement that individuals carry health insurance, since that doesn’t take effect until next year. Considered authoritative by experts, the CDC report contradicts popular story lines from both ends of the political spectrum. On the right, Trump and others warn that Obamacare is “imploding.” (Instead, enrollment is fairly resilient.) On the left, Democrats blame Trump administration “sabotage” for coverage losses. (No hemorrhaging was found.) “It’s a testament to the high value people place on health insurance,” said Katherine Hempstead, a senior health policy adviser at the nonpartisan Robert Wood Johnson Foundation. “People will tenaciously hang on to their health insurance.” Still, the survey found some worrisome indicators of issues potentially ahead: —The uninsured rate rose among “not poor” adults. (Translation: middle class.) That increase was statistically significant, rising to 8.2 percent in 2017. Hempstead said it may reflect the impact of sharp premium increases for individual plans for people in the solid middle class, who aren’t eligible for subsidized coverage under the ACA. “They are uniquely required to pay the full retail cost of health care,” she said. —The uninsured rate also rose significantly in states that have not taken advantage of the ACA’s Medicaid expansion for low-income people. It averaged 19 percent for adults in states that had not expanded Medicaid, a big difference from about 9 percent uninsured in states expanding low-income coverage. The Medicaid expansion survived repeal efforts and several states are moving to join the 32 others, plus Washington, D.C., that have expanded. Last year was tumultuous for health care, with Trump and Congress finally poised to deliver on the GOP vow to repeal President Barack Obama’s signature law. After repeated tries, the effort collapsed in the Senate. But Republicans did manage to undo the law’s unpopular requirement that most Americans maintain coverage or risk fines. Many experts believe the number of uninsured will increase when repeal of the so-called individual mandate goes into effect in 2019. Trump also used his executive authority to undermine Obama’s law. He pulled the plug on legally contested subsidies for deductibles and copayments, triggering a spike in premiums. His administration cut the HealthCare.gov sign-up season in half, and slashed the ad budget. Changes pending this year will allow insurers to offer lower-cost plans that have fewer benefits, and can also turn away people in poor health. Separately, the CDC survey showed no slowing down of the longstanding shift to high-deductible health insurance, with nearly 44 percent of Americans now in plans that require individuals to pay at least $1,300 of medical bills each year, or $2,600 for family coverage. Two independent private surveys have recently shown an increase the U.S. uninsured rate, but the CDC’s approach is different. The government survey relies on face-to-face interviews, not telephone polling. And it’s based on data from about 78,000 people — a very large pool. “This report is as credible a data source on the uninsured as we have,” said Wilensky. Republished with the permission of the Associated Press.
Rise in premiums lays bare 2 Americas on health care
Michael Schwarz is a self-employed business owner who buys his own health insurance. Subsidized coverage through “Obamacare” offers protection from life’s unpredictable changes and freedom to pursue his vocation, he says. Brett Dorsch is also self-employed and buys his own health insurance. But he gets no financial break from the Affordable Care Act. “To me, it’s just been a big lie,” Dorsch says, forcing him to pay more for less coverage. Schwarz and Dorsch represent two Americas, pulling farther apart over former President Barack Obama‘s health care law. Known as the ACA, the law rewrote the rules for people buying their own health insurance, creating winners and losers. Those with financial subsidies now fear being harmed by President Donald Trump and Republicans intent on repealing and replacing the ACA. But other consumers who also buy their own insurance and don’t qualify for financial help feel short-changed by Obama’s law. They’re hoping repeal will mean relief from rising premiums. The ACA sought to create one big new market for individual health insurance in each state. It required insurers to accept all customers, regardless of medical problems. And it provided subsidies to help low- and moderate-income people afford premiums. These newly vested ACA customers joined consumers already in the market, to make a new insurance pool. Policies offered to all had to be upgraded to meet new federal standards for comprehensive benefits, raising premiums. And many of the new customers turned out to be sicker than insurers expected, pushing rates even higher. Consumers who didn’t qualify for government financial help wound up bearing the full cost of premiums. They also faced the law’s new requirement to carry health insurance or risk fines. “One (group) is angry and one is incredibly grateful,” said Robert Blendon of the Harvard T.H. Chan School of Public Health. If Trump and congressional Republicans aren’t careful, their actions could stoke fresh grievances without solving longstanding problems of access and cost. Consider what happened to Schwarz and Dorsch this year, as premiums for a standard plan through HealthCare.gov jumped an average of 25 percent. Schwarz and his wife are in their mid-20s and live in Tampa, Florida. He has his own commercial photography business and she’s pursuing a graduate degree in speech-language pathology. The sticker price of their HealthCare.gov policy went up about 20 percent, but what they pay monthly is about $115 lower than last year. Not only did their subsidy cover the rise in premium, they’re also getting more help because their income went down when Schwarz’s wife returned to school full time. “Being uninsured is not an option,” said Schwarz. If Republicans take away his subsidy, “I would have to change careers and find a job that offered health insurance,” he said. Dorsch and his wife live in Wilmington, Delaware, and are in their mid-50s. He has a wholesale business supplying electronics to retail stores and has been buying his own health insurance for years. He gets no financial help from the ACA. Dorsch said their insurance company wanted to raise the monthly premium to $2,050, or nearly $25,000 a year. They settled for a skimpier plan that still costs $1,350 a month and has a very high deductible. “In four years my health insurance has more than doubled and I have less coverage,” said Dorsch. “It’s ludicrous.” He voted for Trump. “He saw the reality that Obamacare has been a nightmare for most Americans, unless you are poor or in a very difficult situation,” said Dorsch. The Congressional Budget Office estimates that the pool of people buying individual health insurance is basically split down the middle among subsidized customers like Schwarz and those who get no help, like Dorsch. Republican proposals to tie tax credits to age, not income, would help Dorsch. But they may not be generous enough for Schwarz. “It’s trying to find the way to help the one without hurting the other that’s really tricky,” said Nicholas Moriello, a health insurance broker from Newark, Delaware. “If we had a way to help the person whose premium has become unaffordable without hurting the person we are currently subsidizing.” Caroline Pearson, of the consulting firm Avalere Health, studied consumers on government marketplaces like HealthCare.gov — where nearly 90 percent get subsidies — and compared them with those who purchase directly from an insurer and pay full cost. Among Avalere’s findings: — The majority of consumers in the government marketplaces live in lower-income neighborhoods with high unemployment. However, among those who purchase directly from an insurer, about 30 percent live neighborhoods with a median income of $100,000 or more. — Consumers in the subsidized market are generally costlier to cover. For those with a standard plan, per-person medical claims averaged $376 per month in 2015, compared to $312 for unsubsidized customers who bought policies directly from an insurer. — The subsidized market is important in states that voted for Trump. In Florida, for example, 70 percent of individual policyholders purchase through HealthCare.gov. In Georgia, it’s 62 percent. “Obamacare helped a lot of lower-income people with high health needs who previously couldn’t afford insurance,” said Pearson. “It overlooked the fact that there are a lot of people who are relatively healthy and who didn’t want the increased benefits. More sick people drove up premiums, which is resulting in some people feeling like they are worse off.” Republished with permission of The Associated Press.
Poll: Only about 1 in 4 wants Donald Trump to repeal health law
Only about one in four Americans wants President-elect Donald Trump to entirely repeal his predecessor’s health care law that extended coverage to millions, a new poll has found. The postelection survey released Thursday by the nonpartisan Kaiser Family Foundation also found hints of a pragmatic shift among some Republican foes of “Obamacare.” While 52 percent of Republicans say they want the law completely repealed, that share is down from 69 percent just last month, before the election. And more Republicans now say they want the law “scaled back” under the new president and GOP Congress, with that share more than doubling from 11 percent before the election to 24 percent after. Kaiser CEO Drew Altman said the foundation’s polling experts aren’t quite sure what to make of that finding, and will continue to track the apparent shift in future polls. The organization is a clearinghouse for information and analysis about the health care system. It could be that some Republicans “got a protest vote off their chests, and they’re done with that,” Altman said. “They now have a more moderate position.” After branding the Affordable Care Act a “disaster” during an election campaign that saw big premium hikes unveiled in its closing days, Trump has been saying he’d like to keep parts of the law. On Capitol Hill, Republican leaders are trying to choreograph a legislative dance that would let them quickly repeal “Obamacare,” then allow an interlude to segue to a replacement. The complex undertaking is fraught with political risk, because success is not guaranteed. It could disrupt coverage for millions by destabilizing the law’s already fragile health insurance markets, such as HealthCare.gov. The poll found some skepticism about that approach. Forty-two percent of those who want the 2010 health care law repealed said lawmakers should wait until they figure out the details of a replacement plan before doing so. Americans were divided on next steps for President Barack Obama‘s signature law. Overall, 30 percent said the new president and Congress should expand what the law does, and another 19 percent said it should be implemented as is. On the other side, 26 percent said the law should be entirely repealed and 17 percent called for it to be scaled back. Among Trump voters, 8 in 10 viewed the health care law unfavorably, and half wanted it entirely repealed. As Republicans start to make changes in health care, potentially revamping Medicare and Medicaid as well, the politics of the issue could turn against them, Altman said. “They are going to go from casting stones to owning the problem,” he said. The poll found majorities across party lines support many of the health care law’s provisions, but not its requirement that individuals have coverage or risk fines, and its mandate that medium-to-large employers pay fines if they don’t offer health insurance. Among the provisions with support across party lines: — Allowing young adults to stay on a parent’s insurance until age 26. — No co-payments for many preventive services. — Closing the Medicare prescription drug coverage gap known as the “doughnut hole.” — Financial help for low- and moderate-income people to pay their insurance premiums. — A state option to expand Medicaid to cover more low-income adults. — Barring insurance companies from denying coverage because of a person’s medical history. — Increased Medicare payroll taxes for upper-income earners. The telephone poll was conducted from Nov. 15-21 among a nationally representative random digit dial sample of 1,202 adults, including people reached by landlines and cellphones. The margin of sampling error is plus or minus 3 percentage points for the full sample. For subgroups, the margin of sampling error may be higher. Republished with permission of The Associated Press.
Early sign-ups for health care law are steady, but no surge
A little more than 1 million people renewed health coverage or signed up for the first time through HealthCare.gov around the start of open enrollment, which coincided with a GOP election sweep that’s likely to scramble President Barack Obama’s signature law. The figures released Wednesday by the Obama administration represent steady sign-ups but no enrollment surge so far. The overall number is fairly comparable to early sign-ups last year, but the share of new customers is down. They accounted for 24 percent of the total so far this year, compared with 34 percent in the first two weeks of last year’s open enrollment season. Nearly 1.1 million people had enrolled last year by about the same time. The 2017 early sign-up figures are for Nov. 1-12, while the closest numbers from last year cover a full two weeks. Even before the election that put Republicans in charge, the health care law was facing strong headwinds in 2017. The remaining uninsured are harder to reach and persuade. Premiums for a standard plan are going up an average of 25 percent in the 39 states served by HealthCare.gov, and insurer exits have left about one-third of U.S. counties with only one carrier. President-elect Donald Trump and the Republican-led Congress are pledging to repeal and replace the 2010 Affordable Care Act, although it has reduced the nation’s uninsured rate to a historic low of about 9 percent. It’s shaping up as the most volatile open enrollment season since HealthCare.gov went live in 2013 and the computer system didn’t work. Health and Human Services Secretary Sylvia Burwell has set a goal of signing up 13.8 million people through the federal HealthCare.gov and state-run insurance markets, which offer taxpayer-subsidized private coverage to people without access to health care through their jobs. That would be an increase of about 1 million from the last open enrollment, so attracting new people is crucial. The White House is hoping that robust numbers will translate into a strong closing argument for keeping many of the law’s essential parts. Even though premiums are going up significantly, administration officials say most people will be cushioned from the impact because they receive subsidies designed to rise as their insurance costs increase. But an estimated 5 million to 9 million people who buy individual policies outside the law’s markets face the full brunt of increases. During the campaign, Trump said the health overhaul was a “disaster,” but now he is signaling that he doesn’t want to take away coverage from the millions of people who have benefited. Independent studies estimated that Trump’s campaign plan would have caused 18 million to 20 million people to lose health insurance. Republicans in Congress are puzzling over how to follow through on their promise to repeal the health care law while at the same time maintaining p Republished with permission of the Associated Press.
