Sun Sentinel Palm Beach Edition
Obamacare is still not dead: Enrollment to begin Thursday
As the sixth Affordable Care Act open enrollment period approaches its Nov. 1 kickoff, the long-term prognosis is as cloudy as ever, for reasons bound up in partisan politics and the insurance marketplace.
But the short-term diagnosis is stable. Health insurance coverage will be available for 2019 that complies with all of the mandates enacted under then-President Barack Obama in 2010.
Three insurers are offering plans in Palm Beach, Broward and Miami-Dade counties: Market leader Florida Blue, with a range of plans from budget-priced HMO plans to benefitspacked preferred provider plans (PPO); plus two socalled “narrow network” insurers — Molina Healthcare and Ambetter from Sunshine Health — that offer lower premiums to enrollees willing to live with a smaller selection of doctors.
Known as Obamacare, the ACA has hung in there even though many were preparing to give it up for dead after the 2016 presidential election.
A big reason: Insurers are making money off their Obamacare plans, because federal law still requires the government to heavily subsidize premiums and health-care costs for lowincome enrollees.
“In 2017, insurers started rebounding in their financial performance,” said Cynthia Cox, a health insurance policy expert for the nonprofit Kaiser Family Foundation. “But even in the last year or so, we’ve seen insurers on average have become quite profitable in this market. Average growth margins per enrollee have increased sharply, and the share of premiums that insurers are paying out in the form of medical claims is dropping.”
In Florida, roughly 1.72 million people enrolled in an ACA plan for 2018 — nearly as many as the 1.76 million the previous year, despite President Donald Trump’s administration cutting open enrollment from three months to six weeks. Of Florida’s enrollees, 92 percent qualified for subsidies that reduced what would have been a $595 monthly premium to an average of $70.
Costs won’t change much for those enrollees, including about 762,000 from South Florida, in 2019.
Nationwide, the numbers of subsidized enrollees remained stable, increasing from 8.7 million in 2015 to 9.2 million in 2018, according to Kaiser figures.
Those aren’t the enrollees that prompt concerns about the ACA’s long-term health. It’s the enrollees who make too much money to qualify for government subsidies and are forced to pay full price for coverage who proponents worry could destabilize the ACA
insurance pool.
They include small business owners and self-employed contractors, such as mortgage brokers, real estate salespeople, accountants, some doctors and nurses, and early retirees with investment incomes. They bore the brunt of steep rate increases imposed by insurers last year under the — correct — expectation that the Trump administration would cut off direct cost shares to insurance companies.
Too many are finding less value for more money, said Cliff Eserman, a Wilton Manors-based health insurance broker.
Eserman said many of the moderately priced HMO plans that his clients purchase raised the out-ofpocket maximum from $7,350 to $7,900 in their 2019 plans. Also, availability of specialists continues to tighten for members of the budget-priced “narrow” network plans, he said.
Too often, doctors who are listed as “in-network” on these plans are telling prospective patients that their patient loads are at capacity or that they were listed among a networks’ providers by mistake, Eserman said.
“A lot of the networks listed on the computer are wrong,” he said. “One or two of every 10 doctors listed in a network are either not in that network or not accepting new patients.”
And costs for non-subsidized enrollees have skyrocketed in recent years, their participation in ACAcompliant health plans decreased from 6.4 million in 2015 to 3.9 million in 2018, according to Kaiser data.
Those younger, healthier enrollees are relied upon to fund medical care costs of older, sicker members. But last year, Congress made it easier for younger enrollees to drop out of the pool by eliminating the federal tax penalty for going without health insurance.
Meanwhile, the Trump administration has been following through on its promise to reduce health insurance costs by loosening regulations on short-term health plans that don’t cover preexisting conditions. While the resulting plans might cost less than plans that must cover preexisting conditions, a switch to them by too many healthy ACA enrollees could destabilize the ACA pool by making compliant plans too expensive, prompting more people to pull out of the ACA market and hasten the death spiral.
But insurers offering subsidized and non-subsidized plans “have to keep that business as if it’s one single risk pool,” Cox said. “So to some extent, the fact that there are subsidies … that are cushioning [low-income] enrollees from experiencing these rate impacts, that is helping the [nonsubsidized] off exchange market now.”
Kaiser Family Foundation analysts say it’s important for enrollees considering switching to low-cost, short-term plans to understand they likely won’t be allowed to buy coverage with conditions such as cancer, diabetes, HIV/ AIDS, Hepatitis C, heart disease, mental health or substance use disorder.
And if they develop a serious health problem while enrolled in a low-cost, short-term policy, they likely won’t be allowed to renew their coverage, the analysts said.
Because insurers increased prices last year in anticipation that the Trump administration would stop direct cost share payments to insurers, prices for many plans this year are expected to be reduced.
Along with eliminating direct cost share payments to insurers and overturning the tax penalty for dropping health coverage, the Trump administration also cut the federal budget for enrollment assistance — known as “navigator” programs — by 85 percent this year.
The federal Department of Health and Human Services, which administers ACA benefits, decided that enrollment assistance is no longer needed at levels comparable to previous years, said Jodi Ray, who heads the state’s largest navigator program.
But Ray said her organization still received hundreds of calls a day during Open Enrollment last year. “What I know is that people find health insurance to be complicated,” she said.
Karen Egozi, who heads enrollment outreach and assistance in the tricounty region, said the number of navigators available here decreased from 45 last year to 12 this year.
With fewer navigators available for face-to-face counseling, the assistance program, funded through the Epilepsy Foundation of Florida, will rely more heavily on assistance by phone and over the internet, Egozi said.
“Our purpose is to help people who need assistance,” said Egozi, the Epilepsy Foundation’s CEO. “We’re going to just keep moving forward — to do our best to people enrolled.”
The Open Enrollment period is from Nov. 1 to Dec. 15.