Health ex­change rates are ris­ing

In its fourth year, in­sur­ance pro­gram tries to boost rolls

Baltimore Sun - - FRONT PAGE - By Mered­ith Cohn

As thou­sands of Mary­lan­ders be­gin en­rolling in health in­sur­ance on the state ex­change start­ing next week, they’ll face sig­nif­i­cantly higher pre­mi­ums that na­tion­wide have turned the Af­ford­able Care Act into even more of a po­lit­i­cal is­sue that it al­ready was.

Rates for in­sur­ance plans pur­chased through the on­line mar­ket­place will in­crease no less than 20 per­cent, mak­ing it even more im­por­tant for the state health of­fi­cials and ad­vo­cates to con­duct out­reach and ex­plain the sub­si­dies avail­able to many buy­ers.

Mary­land ex­change of­fi­cials also are tout­ing a stream­lined web­site, new mo­bile app and wide­spread as­sis­tance to make the open en­roll­ment pe­riod — slated to run from Nov. 1 to Jan. 31 — go more smoothly than ever.

The soar­ing cost of in­sur­ance is per­haps the big­gest grow­ing pain for what is known as Oba­macare, the law de­signed to cover peo­ple who don’t get in­sur­ance through their em­ployer. The costs have prompted some in­sur­ers to stop of­fer­ing in­sur­ance on the ex­changes, in­clud­ing Unit­edHealth­care in Mary­land.

That’s added fuel to many Repub­li­cans’ ar­gu­ments to re­peal the law, a po­si­tion echoed by Don­ald Trump, the party’s pres­i­den­tial can­di­date. Mean­while, his Demo­cratic ri­val, Hil­lary Clin­ton, has called for a pub­lic in­sur­ance op­tion to spur more com­pe­ti­tion and higher sub­si­dies for con­sumers to buy cov­er­age — po­si­tions Pres­i­dent Barack Obama has em­braced.

“At end of day, if the prospec­tive cus­tomers don’t see value for the price they pay, it’s tough to get them to buy,” said Al­fred W. Red­mer Jr., com­mis­sioner of the Mary­land In­sur­ance Ad­min­is­tra­tion, which re­cently ap­proved rate hikes of 20 per­cent to 30 per­cent for in­sur­ers sell­ing 2017 plans. “A broad seg­ment of the mid­dle class finds the in­sur­ance un­af­ford­able.”

Ex­change of­fi­cials and con­sumer ad­vo­cates note that sub­si­dies will in­crease

with the pre­mi­ums and some con­sumers can get help pay­ing out-of-pocket costs.

The law has suc­ceeded in get­ting more peo­ple in­sured. The state’s unin­sured rate dropped to 6.6 per­cent in 2015 from 10.2 per­cent in 2013, ac­cord­ing to the U.S. Cen­sus Bureau. Be­fore the Af­ford­able Care Act of 2010, about 14.5 per­cent lacked in­sur­ance, ac­cord­ing to es­ti­mates from the Hill­top In­sti­tute at the Univer­sity of Mary­land, Bal­ti­more County. Some state res­i­dents re­main in­el­i­gi­ble be­cause they are un­doc­u­mented im­mi­grants.

This year, nearly 163,000 Mary­lan­ders en­rolled in pri­vate health plans on the ex­change, a gain of 33 per­cent from the year be­fore. And more than 278,000 were added to the state rolls for Med­i­caid, the in­sur­ance pro­gram for those with lim­ited in­comes.

Carolyn Qu­at­trocki, who stepped aside as the ex­change’s ex­ec­u­tive di­rec­tor for a po­si­tion in the state at­tor­ney gen­eral’s of­fice, said she’s pleased the ex­change al­ready has got­ten so many peo­ple in­sur­ance who didn’t have it be­fore.

“It’s im­por­tant to take the long view,” she said.

Dur­ing open en­roll­ment, con­sumers will de­cide whether to keep or change their cov­er­age. The Mary­land ex­change has set a goal this year of en­rolling about 171,000 in pri­vate plans, up about five per­cent.

Qu­at­trocki’s re­place­ment, Jonathan Kromm, takes the helm as the ex­change shifts fo­cus to reach­ing hold­outs and mak­ing en­roll­ment and re-en­roll­ment eas­ier. He said many peo­ple were ini­tially frus­trated be­cause the web­site didn’t work, and even in sub­se­quent years some found the process con­fus­ing. Some now need help find­ing more af­ford­able plans.

“Go­ing for­ward we have to get in­creas­ingly more fo­cused on the pop­u­la­tions that re­main unin­sured and tai­lor our mes­sag­ing and out­reach,” Kromm said. “We have to make the case that in­sur­ance is af­ford­able even as rates have gone up.”

Mary­land lost only one ex­change in­surer, leav­ing four oth­ers sell­ing poli­cies for 2017. Unit­edHealth­care, which pulled out of all but a hand­ful of states, in­sured about 10 per­cent of those on Mary­land’s ex­change this year.

CareFirst BlueCross BlueShield cov­ered about 60 per­cent of peo­ple en­rolled through the state ex­change, Kaiser Per­ma­nente cov­ered about 23 per­cent and Cigna cov­ered 1 per­cent. About 7 per­cent got in­sur­ance through Ev­ergreen Health, a strug­gling co-op seek­ing to be­come a for-profit in­surer.

“The key is­sue na­tion­wide has been the will­ing­ness of in­sur­ers to par­tic­i­pate,” said Justin Gio­van­nelli, an as­so­ciate re­search pro­fes­sor at Ge­orge­town Univer­sity’s Cen­ter on Health In­sur­ance Re­forms. “The idea is to have a com­pet­i­tive mar­ket­place, and if you have few will­ing to com­pete it puts con­sumers in a tough spot.”

Many states have more in­sur­ers than Mary­land, but Gio­van­nelli said some now have only one or two and face larger rate in­creases.

Premium sub­si­dies will help cover costs, but con­tin­ued dou­ble-digit rate hikes even­tu­ally could put in­sur­ance out of reach. He said it’s un­clear if this year is a “cor­rec­tion” aimed at help­ing in­sur­ers ac­count for a less healthy pool of con­sumers than ex­pected, or if more large in­creases are com­ing.

Fed­eral health au­thor­i­ties are seek­ing to at­tract more young adults who had the high­est unin­sured rates be­fore the Af­ford­able Care Act passed, a move at­tacked by crit­ics such as the con­ser­va­tive Her­itage Ac­tion for Amer­ica for lead­ing more peo­ple to a “fail­ing” sys­tem.

Gio­van­nelli said the chal­lenge now is en­rolling more healthy peo­ple gen­er­ally. That will mean ex­plain­ing that sub­si­dies are avail­able and there are tax penal­ties for go­ing with­out in­sur­ance. The 2016 penalty is 2.5 per­cent of house­hold in­come or $695 per adult, which­ever is higher.

With Repub­li­cans con­tin­u­ing their leg­isla­tive and le­gal as­saults on the health law, he said the ex­changes will have to cut through the “vo­cal and con­certed at­tacks ... that cre­ate a po­ten­tially chal­leng­ing en­vi­ron­ment even in a state like Mary­land.”

Vin­cent DeMarco, pres­i­dent of the Mary­land Ci­ti­zens’ Health Ini­tia­tive, said reach­ing the unin­sured gets tougher each year es­pe­cially if they have en­trenched opin­ions. The sim­pler web­site and new mo­bile app should help ap­peal to younger and lower-in­come con­sumers who of­ten ex­clu­sively use smart phones for In­ter­net ac­cess, he said.

His group has cre­ated a net­work of faith lead­ers to reach out to their com­mu­ni­ties and run ad­ver­tise­ments fea­tur­ing celebri­ties.

“We’re all fo­cused on be­ing more tar­geted,” he said. “We have to make sure peo­ple who are re­luc­tant to sign up be­cause they heard of costs go­ing up know there are sub­si­dies.”

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