Hits keep coming on health exchanges

Doubt sowed by Trump administration worsens exodus of insurers, experts say

USA TODAY

More than 1,370 counties now have only one insurer that will sell on the Affordable Care Act exchanges next year, while about 40 have none, an analysis of the latest data by the Robert Wood Johnson Foundation and USA TODAY shows.

The exodus of insurers is due in large part to the uncertainty created by the Trump administration, industry and other health care experts say. And even some insurers that submitted 2018 plans and proposed rates with state insurance commissioners are publicly wavering on whether they will follow through and sell them. They have until at least midSeptember to change their minds.

Insurers are increasingly exiting the off-exchange market as well, forcing wealthier people who buy unsubsidized plans to rely on the very “Obamacare” marketplace the administration and Republicans in Congress have pilloried and worked to undermine. And that’s if there are still insurers selling plans at all in some counties.

President Donald Trump has often referred to these people as “‘Obamacare’ victims” because of steep premium increases. However, about twothirds of the rate increases proposed for 2018 are due to the administration’s own actions, the consulting firm Oliver Wyman estimated last month.

The Affordable Care Act replacement bill that could come up for a vote after senators return from their July 4 recess includes some funding for subsidies that reduce deductibles and co-payments for about 7 million people. Trump has refused to commit to continue funding them, and his administration has suggested it might not enforce the mandate that people have health insurance.

Insurers support the mandate because healthier people are less likely to buy plans if there’s no penalty, and they’re needed to offset the cost of covering sicker people.

Rate hikes proposed so far range from 11 percent in Vermont to 50 percent in New York. The national range at this point would be far lower if it weren’t for this “Trump tax” of insurers pricing with the assumption that they won’t be reimbursed for the subsidies or that the mandate to have insurance won’t be enforced, said Charles Gaba, a data expert who runs ACASignups.net.

Medica, Iowa’s reluctant only insurer on or off the exchange, just announced requested rate increases of nearly 45 percent.