ACA ex­changes to re­open amid po­lit­i­cal, pric­ing pres­sures

Modern Healthcare - - THE WEEK AHEAD - —Shan­non Much­more

The next open en­roll­ment sea­son for Af­ford­able Care Act ex­change plans opens Tues­day amid the charges and coun­ter­charges of a heated po­lit­i­cal cam­paign.

But the real ac­tion will take place over the next two months as mil­lions of unin­sured Amer­i­cans de­cide whether they will fi­nally sign up for plans or pay the heftier penal­ties that go into ef­fect next year. Ris­ing pre­mi­ums and a lack of mar­ket­place com­pe­ti­tion may wind up do­ing more dam­age than pol­i­tics, es­pe­cially if the elec­tion re­sults fol­low the polls and Don­ald Trump loses.

The CMS said last week the av­er­age pre­mium in­crease for bench­mark plans was 25%. Some states have re­ported in­creases of more than 50%. Since three ma­jor in­sur­ers an­nounced they were dras­ti­cally scal­ing back their par­tic­i­pa­tion in the ex­changes, a hand­ful of states find them­selves with only one in­surer in the ex­change. As a re­sult, the CMS is ex­tend­ing the sign-up dead­lines for peo­ple whose plans are be­ing dis­con­tin­ued.

HHS noted that most con­sumers are shielded from pre­mium in­creases be­cause they will also get an in­crease to their sub­si­dies. A re­cent re­port states most con­sumers would be able to find a plan with a pre­mium of $75 a month or less.

HHS has said nearly 80% of con­sumers will have a choice of two or more in­sur­ers and 50% will be able to choose be­tween three or more. The agency re­cently pre­dicted en­roll­ment for 2017 at 13.8 mil­lion. Con­sumers face a $695 or 2.5% of in­come penalty if they re­main unin­sured in 2017.

The last day of en­roll­ment is Jan. 31. Con­sumers need to be en­rolled by Dec. 15 for cov­er­age that starts Jan. 1 and by Jan. 15 for cov­er­age be­gin­ning Feb. 1.

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