ACA enrollment opens as program stabilizes

33 plans offered in Harris County as Obamacare shows its tenacity

Open enrollment for health plans under the Affordable Care Act begins Thursday, an annual event that his year will get under way with little fanfare or outrage — something supporters see as a testament to the adhesiveness of a law that has been under attack from the moment it was born.

In Harris County, residents will have their choice of 33 individual health plans offered by four insurers, almost identical as last year. The biggest change is that average premiums have either gone down or increased only modestly.

Stability is something new after all of the years of troubled finances, surging premiums, bitter political battles and predictions of the imminent doom of the law known as Obamacare.

The Republican-controlled Congress failed to kill off the law last year. The Trump administration has launched a series of efforts to unravel it, including slashing the advertising budget for enrollment, cutting off funding for community groups who help with signups, shrinking the enrollment period by half and eliminating the penalty for not having insurance.

But its popularity has only grown. A Fox News poll this month showed 54 percent of likely voters favor the law, compared to 38 percent in March 2015 in the same

poll. About 1 million Texans bought insurance plans on the federal exchange last yer.

“The law is like the Energizer bunny,” said Kevin Nix, a spokesman for Legacy Community Health, the largest communitybased health care system in Texas. “It keeps going and going and going,”

Perhaps the clearest sign of Obamacare’s growing acceptance is the midterm election, in which Democrats who once ran from the law are embracing it and its protections for people with pre-existing conditions and Republicans are touting their support, if not for Obamacare itself, than something similar.

Consider it was but two years ago that the nation’s largest insurers beat a hasty retreat from the federal exchange in Houston. First came United Healthcare, which said it could no longer afford to offer ACA plans. Then it was Aetna, Humana and Cigna, all singing similar tunes of unsustainable losses from not being able to predict the cost of covering the sick and chronically ill under a new model that would not let them charge such patients more or deny them outright.

Remaining insurers sought eyepopping rate increases to counteract their own losses in the individual ACA market. In 2016, Blue Cross and Blue Cross and Blue Shield of Texas, the state’s largest insurer, asked for nearly 60 percent rate hike, ultimately whittled by the federal government to just under 50 percent. In 2017, another local insurer, Community Health Choice, got a 49 percent rate increase.

Texas always hostile

From the very beginning few states have been as inhospitable as Texas, which continues to lead the nation in the rate and number of uninsured. When given the choice to expand Medicaid, the government health coverage for the poor, Texas leaders said and continue to say no, even though under the law the federal government picks up most of the tab.

By some estimates the state will have left $100 billion on the table over a decade because of its refusal. Former Gov. Rick Perry saw Obamacare as an intrusion by the federal government. Earlier this year, Texas Attorney General Ken Paxton filed a lawsuit, joined by 19 other state attorneys general, seeking to declare the entire health law unconstitutional. The case is still pending in federal court.

In March, 2017, U.S. Rep. Kevin Brady, R-The Woodlands, a steadfast opponent and architect of a replacement law, wrote in a guest editorial for Chron.com, a web affiliate of the Houston Chronicle. “The end of ObamaCare has begun,” Brady said. “The controversial, struggling health care law set sail seven years ago, helping some but hurting millions of patients, families and local businesses. Today experts from both political parties acknowledge it's a sinking ship leaving even more Americans in a lurch in the near future.”

Brady did not respond Tuesday to requests for comment.

Still, time marched on and insurers again started making money as they figured out who their customers would be. For instance, Health Care Service Corporation, the Chicago-based parent company of Blue Cross and Blue Shield of Texas, made $1.26 billion in profits last year. That is more than a tenfold increase from the previous year’s $106 million, and a far cry from the $281.9 million loss in 2014, according to financial records.

Found its stride

“Over the last several years, we reduced our expenses, managed medical costs across the health care system and remained true to our commitment to stand with customers, even in tough market conditions when others wavered,” said Paula Steiner, CEO of HCSC in a statement this year. She also announced the nonprofit company would invest $1.5 billion over three years to reduce health care costs for its members.

For 2019, a menu of 33 individual plans will be offered in Harris County. That is one fewer than last year but the number of insurers remains unchanged: Blue Cross and Blue Shield of Texas, Community Health Choice, Molina Healthcare, and Ambetter from Superior HealthPlan.

As in the previous enrollment period all of the plans except Ambetter are health maintenance organizations (HMO). Ambetter offers a choice of exclusive provider organization (EPO) plans which are similar to HMOs but typically do not cover care outside of the plan's provider network.

For the coming year there will be eight bronze individual plans with an average price of $341 per month without a subsidy to lower premium price. Insurers will offer 17 silver plans, at an average price of $437 per month without subsidy; and eight eight gold plans at an average monthly cost of $517 without subsidy, according to the healthcare.gov tool to shop for plans.

In Texas 90 percent of enrollees qualify for subsidies, according to a study by the Kaiser Family Foundation.

Michael Morrisey director of Texas A& M University’s Program for Health Policy Research, admits there were times when the law’s survival “looked iffy.” But he predicts it has found its stride not only with the insurance industry but also with consumers, especially those with health needs. Once a benefit is in place, he said, “it makes it difficult to take away.”