Some ACA rates drop

Obamacare plans stabilize even as Texas fights to kill law

Something crazy happened on the way to 2019 enrollment for Affordable Care Act insurance plans. Rates went down. After years of teeth gnashing about unsustainable industry losses and astounding rate increases, insurers in the Houston area have changed course. They say the market has stabilized and, after years of experience, they know more about the people the will cover, which is a key factor in determining rates.

One of the most striking examples is Blue Cross and Blue Shield of Texas, which filed a request for 2019 to cut rates by about 6 percent for two ACA individual plans after making national headlines by requesting increases for 2017 of nearly 60 percent. Federal officials whittled that request to less than 50 percent, but Blue Cross came back the next year with 24percent rate increase request, which was reduced to about 20 percent.

The rate reductions come, ironically, as the law known as Obamacare continues to come under attack by the Trump administration and its Republican allies. A lawsuit filed by Texas Attorney General Ken Paxton and joined by 19 other states earlier this year challenges the constitutionality of the health law. The case is now before a federal judge in Fort Worth, but could ultimately end up in the U.S. Supreme Court.

Since Trump took office, his administration and the Republican-controlled Congress have taken multiple steps to undermine the law’s success, including repealing the penalty for not having insurance and expanding the availability of so-called skimpy plans, which are cheaper, but tend to offer limited coverage. Both are seen by critics as siphoning younger, healthier people from the risk pool and forcing sicker patients to pay higher and

higher premiums until they are priced out of market, forcing it to collapse.

Earlier this month , the Centers for Medicare and Medicaid Services, known as CMS, said it would dramatically cut grants to help boost 2019 enrollment, slashing funding in Texas to $1.4 million from about $61 million in 2018.

Market ‘more predictable’

Opponents continue to call for the law’s repeal. Robert Henneke, general counsel for the Texas Public Policy Foundation, an Austin think tank that joined Paxton’s lawsuit, said high premiums and limited choices hurt people. “The Affordable Care Act continues to be a disaster for Americans,” he said in a statement.

But supporters say the rate declines show the ACA is working much as economists predicted, expanding coverage and slowly bringing costs under control — despite unrelenting efforts to undermine it.

“As the market matures it becomes more predictable,” said Elena Marks, president of Houstonbased Episcopal Health Foundation. “We are this many years in and that piece is beginning to work.”

Timothy Jost, a professor at Washington and Lee School University School of Law in Lexington, Va., and an expert on the health care law, said he expected rates to jump again in 2019, given the adverse policy changes. Declines, he said, might be a market correction, offsetting rates that rose too much in previous years.

“By rights, this would be the year that there would be big increases,” he said. “After two years of huge increases, they overshot their mark and now they’re dialing back.”

Blue Cross said in a statement that setting rates requires complex calculations that not only capture past experience but incorporate predictions of the future. The state’s largest insurer said it was pleased to request rate decreases, but acknowledged, “Health coverage still remains out of reach for thousands of people in Texas.”

More than 1 million Texans signed up for health insurance through the federally run exchange last year, even though the Trump administration cut the enrollment period to 45 days from the previous 90. The sixth annual Obamacare enrollment also will last 45 days, running from Nov. 1 through Dec. 15.

In the Houston area , four insurers will offer individual plans on the exchange next year. In addition to Blue Cross and Blue Shield, other insurers will be Community Health Choice, Molina Health Care of Texas, and Ambetter Health, which operates as Celtic Insurance Company.

Community Health Choice, Molina, and Ambetter are seeking rate increases, but ones that are substantially lower than a year ago. Molina, for instance, has asked for a 3.9 percent increase in one of its individual plans for 2019, after receiving a 41 percent increase for 2018.

Community Health Choice, a Houston insurer with about 110,000 members in the region, is asking for an 8.5 percent increase for 2019 after boosting rates by 49 percent this year. Celtic Insurance Company has asked for a 6.4 percent rate increase, compared to a 47 percent increase in 2018.

Still highest in Texas

Premium rate requests are significantly lower throughout the country, according to information compiled by the Associated Press and Avalere Health, a Washington consulting firm. Overall, in 47 states and Washington D.C., the rate increase requested for 2019 averaged 3.1 percent, compared to about 30 percent for 2018, said Chris Sloan, director of Avalere Health.

The proposed average increase in Texas is 3.8 percent, down from 41 percent in 2018 among benchmark plans on the exchange, Sloan said.

For Texas, the question is whether lower premiums, or at least smaller increases, will stop the rise in uninsured residents. New Census data shows Texas continued to have the highest number and highest rate of uninsured in the nation, rising to 17.3 in 2017 from 16.6 percent in 2016. That translates to 4.8 million Texans without coverage in 2017, up from 4.5 million in 2016.

Houston had the highest uninsured rate in the country among the most populous metropolitan areas, 18.2 percent, according to the Census. Dallas-Fort Worth ranked second at 16.5 percent and San Antonio fourth with a 14.5 percent uninsured rate.