Obamacare sign-up may test Trump health policies
The Affordable Care Act’s insurance marketplaces open for a sixth year Thursday with more-stable healthplan choices and rates, plus significant tests of the effects of recent Republican moves to undercut parts of the law.
During the enrollment season — which lasts six weeks, half as long as it used to be — consumers may buy the health coverage created under the ACA at HealthCare. gov or through state exchanges in 11 other states.
This is the first enrollment since Congress removed the law’s penalty for people who fail to carry health insurance. With that federal fine scheduled to vanish in January, this year’s marketplaces will furnish evidence for a longsimmering debate: How much of the nation’s gains lately in health coverage have happened because of the law’s insurance mandate, and will coverage tumble without it?
This enrollment season will also be the first since the Trump administration has been taking steps to circumvent the ACA’s insurance requirements, making it easier for individuals to buy two inexpensive types of insurance that cover less care and lack certain popular consumer protections.
Administration officials tout these short-term health plans and “association Verma health plans” as expanding affordable options, while critics predict they will confuse consumers. Federal health officials have just said they are open to states using the ACA’s subsidies to help people afford insurance premiums for these health plans, but states have not had time to get permission for this enrollment period.
The administration’s senior health officials are claiming credit for causing the marketplaces to be less turbulent than in the past few years, while continuing to argue for an end to the sweeping 2010 health-care law that was President Barack Obama’s prime domestic achievement.
“We have been working tirelessly to fulfill the promises we made to stabilize the market,” Seema Verma, administrator of the federal Centers for Medicare and Medicaid Services, said in mid-October as her agency released an annual compendium of insurance rates in the ACA’s marketplaces. It shows that, for the first time, the average premiums for the most popular level of coverage are dipping slightly for 2019 — by 1.5 percent, with wide variation from state to state.
How much credit the administration deserves for premiums leveling off is a matter of dispute. An analysis by the Kaiser Family Foundation found that rates for the most popular level of ACA health plan are, on average, 16 percent higher than they would have been without the changes by the administration and Congress.
President Donald Trump ended one of two major subsidies built into the law — payments to insurers to cushion them from discounts they must give lower-income customers on out-of-pocket costs. The change prompted predictions that insurers would flee, but for the most part, they stuck around, having already planned on big rate increases. In 15 states, insurance companies are even returning or entering for the first time, Kaiser data show.
One big change is the amount of neutral guidance insurance shoppers will be able to find. The ACA created grants to organizations known as navigators in the states using the federal exchange, but the administration has curtailed money for such groups from $63 million in 2016 to $10 million this year.