Couple worry about rising costs of health plans. Story,
Loss of federal cost-sharing payments adds uncertainty for ACA marketplace enrollees
After Amber Coppings, 39, broke her leg on an icy Lawrenceville sidewalk one evening in January 2016, her Affordable Care Act marketplace plan covered all but $8,000 of the $90,000 charge for her surgery.
“It was still quite a lot of money for us, but it was much more manageable,” said Ms. Coppings. Without the ACA plan she shares with husband and fellow artist Adam Shreckhise, she added, “we would have gone bankrupt.”
That episode came to mind again Friday after Ms. Coppings learned that the federal health officials say they are ending cost-sharing reduction (CSR) payments for insurers to offer lower-cost marketplace plans to low-income individuals.
Like many, she was unsure of the immediate implications.
Pennsylvania state officials have said rates on ACA plans would increase an average 20.3 percent statewide without the payments. Could she and her husband afford a much higher monthly premium than the $264 they currently pay? Will their tax credit go up, too, and would it be enough to offset the premium increase?
“I just had a horrible feeling in my stomach. Here’s this unsteadiness again, this potential catastrophe.”
The Lawrenceville couple are among the more than 150,000 residents in southwestern Pennsylvania who are insured through the marketplace, a key feature of the 2010 Patient Protection and Affordable Care Act commonly referred to as Obamacare.
Like many without access to employer-based coverage, the marketplace made health insurance accessible to them for the first time in more than a decade.
“We own our own home,” she said and during all those years without health insurance “we were always scared we would have to sell it if something went wrong.”
After her accident early last year, “I don’t want to risk being completely uninsured and a plan with a high deductible would be better than none.”
On Friday, she still made a Nov. 3 appointment with the Consumer Health Coalition on the North Side, one of five navigator organizations statewide funded to help consumers decide on a marketplace plan. Her hope is that she and her husband will continue to be covered under one.
In a release Friday, Consumer Health Coalition Executive Director Lou Ann Jeremko encouraged those without insurance to still enroll, or renew, a marketplace plan during the Nov. 1-Dec. 15 open enrollment period.
While ending cost-sharing reduction payments could destabilize the marketplace, the Affordable Care Act “is still the law of the land,” the release stated.
Under that law, insurance companies are required to offer the discounted plans to eligible consumers “and, according to federal law, the federal government is required to pay insurance companies” for doing that, said Leslie Bachurski, director of consumer navigation and organizational development at the coalition.
“If the federal government follows through on not paying CSRs, insurance companies are expected to sue.”
Ms. Coppings’ immediate plan is “to try to become a bit more informed” about what this latest development means for her and her husband.
She said she also intends to challenge her representatives in Congress to explain why they are trying “to change something that made my life better.”