ACA plan sign-ups steady in state

Uncertainty, premium increases haven’t hurt insurance enrollment

The almost certain repeal of the Affordable Care Act and increases in premiums haven’t led to a sharp drop in the number of people in Wisconsin who buy health plans on the marketplaces set up by the law.

But the overall market for health plans sold to individuals and families who buy health insurance on their own could be smaller next year.

As of Dec. 19, 173,755 people in Wisconsin, including 67,805 in Milwaukee County, had signed up for health plans on the federal marketplace, according to the U.S. Department of Health and Human Services.

That was the deadline for coverage to begin on Jan. 1. The open-enrollment period ends on Jan. 31.

At the end of the last open-enrollment peri-

“Our members want our insurance . ... So we have to continue with business as usual.” CATHY MAHAFFEY, CEO, COMMON GROUND HEALTHCARE COOPERATIVE

od, 224,208 people in Wisconsin had bought health plans on the marketplace.

At least some of the people who have bought plans on the marketplace in this open-enrollment period previously bought plans that were not sold on the marketplaces and that are no longer available, said Todd Catlin of Transition Benefits in Brookfield.

How many more people will buy health plans by Jan. 31 is unknown. But Catlin said most people with coverage have bought new plans, were automatically re-enrolled in their existing plans or were assigned to new plans if their health insurer left the market.

A person or family assigned to a plan can change plans up to Jan. 31.

People previously covered by UnitedHealthcare, for instance, were assigned to a new plan offered by Children’s Community Health Plan.

A sampling of health insurers found that enrollment in their plans was relatively stable — though some of that may stem from their picking up customers from insurers who are leaving the market.

Molina Healthcare of Wisconsin said it is seeing strong enrollment growth for 2017 and is on target to meet its goals. So, too, is Common Ground Healthcare Cooperative.

“We really met our expectations this year,” said Cathy Mahaffey, chief executive officer of Common Ground Healthcare Cooperative.

It estimates that 32,000 people have enrolled in its health plans so far, in line with its goal of covering 30,000 to 35,000 people next year.

The enrollment period has even gone relatively smoothly — “not that we still don’t have issues,” Mahaffey said.

People have a better understanding of the steps, she said, and the online marketplace has improved.

Security Health Plan, an affiliate of Marshfield Clinic, has seen an increase in enrollment, said Marty Anderson, its chief marketing officer.

About 28,000 people in 32 counties have enrolled in its plans.

Part of the gains have come from insurers leaving the market. About 800 people previously covered by UnitedHealthcare, for instance, were assigned to plans sold by Security Health.

Anderson expects a fair number of people will buy plans in January.

But Rob Plesha, an actuary and vice president who oversees the individual and small group markets for Unity Health Insurance and Gundersen Health Plan, expects a minimal increase in enrollment going forward.

Most new customers, he said, buy plans by Dec. 15.

The health insurer expects a slight drop in enrollment this year, Plesha said.

Health insurers in the Madison area raised rates by about 25%, an increase higher than many markets in the state. But Plesha said most people who buy plans on the marketplaces receive subsidies and were shielded from the rate increases.

The federal subsidies cap the percentage ofa person’s income that goes toward the cost of insurance.

The people who have been hurt are those who don’t qualify for federal subsidies.

In the Milwaukee area, the least expensive plan for a family of four with 40year-old parents is more than $1,000, with a deductible of $5,000 or more and maximum out-of-pocket expenses of $7,150 for one family member and $14,300 for the family, Catlin said.

All the health plans in the Milwaukee area also exclude at least one health system.

Most people accept the trade-off, particularly if they are receiving a subsidy to help offset the cost, said Jon Rauser of the Rauser Agency, which has offices in Milwaukee and Mequon.

The same doesn’t necessarily hold true for people not receiving subsidies.

In the backdrop of all this is what happens next year or in the next few years.

“It’s very disconcerting,” Rauser said.

President-elect Donald Trump and the Republican leadership in Congress have vowed to quickly repeal at least the parts of the law — those dealing with the budget — that require only 51 votes in the Republican-controlled Senate.

What comes after that is anyone’s guess.

The new administration and Republican-control Congress are expected to follow a course of repeal, delay and replace — repealing the law and delaying its effective date until 2018 or later to give Congress time to come up with replacement for the Affordable Care Act that fulfills Trump’s promise of being “something much better.”

Among the key questions are to what extent a replacement plan would provide subsidies for people who can’t afford health insurance and how it would ensure that people with pre-existing health conditions still will have access to health insurance.

A replacement plan is expected to allow more flexibility in the design, such as benefits and deductibles, of health plans. That could result in lower costs for people who are young and healthy.

Some people who buy their own health insurance are optimistic that repealing the law will benefit them, Rauser said. Others are worried about losing their coverage.

Remaking the health insurance market for individuals and families again will take time. And what would happen in the interim is another unknown.

Health insurers will have to file their 2018 rates in May — though they have until September to pull out of the market.

“We are going through our usual steps,” Mahaffey said. “Our members want our insurance. They want us to be in the market. So we have to continue with business as usual.”

The market for health insurance sold directly to individuals will continue to exist, said Anderson, of Security Health. And he expects Congress to be cautious about destabilizing the market.

But he also acknowledges that there are more than a few questions.

“It’s going to be like 2010 all over again,” he said. “We’ll learn what the new rules of the road are.”