In­sured mov­ing on with ACA

What will 2018 en­roll­ment pe­riod hold for Amer­i­cans?

The Denver Post - - FRONT PAGE - By Tom Mur­phy

As the po­lit­i­cal drama over health care leg­is­la­tion in Wash­ing­ton fades, the rest of the coun­try faces a more im­me­di­ate con­cern: Get­ting in­sur­ance for next year.

The Repub­li­can health plan de­signed to re­place the Obama-era health law known as the Af­ford­able Care Act would not have taken full ef­fect for a few years any­way — and now it’s dead.

“We’re go­ing to be liv­ing with Oba­macare for the fore­see­able fu­ture,” House Speaker Paul Ryan said Fri­day.

That means mil­lions of Amer­i­cans will have to nav­i­gate a cur­rent fed­eral health care sys­tem that, while not “im­plod­ing” as Pres­i­dent Don­ald Trump has said, is at least in flux.

Mary Vavrik, a 57-year-old free­lance de­po­si­tion court re­porter from An­chor­age, Alaska, said she was re­lieved that the cur­rent health law will re­main be­cause she’s happy with the cov­er­age she gets through her ex­change — even as she ac­knowl­edged that re­forms are needed.

“It’s not a per­fect plan, but I’m re­ally grate­ful to have what I do have,” she said.

Prices for in­sur­ance plans of­fered on the pub­lic in­sur­ance ex­changes set up by the health care law have soared in many mar­kets, and choices for cus­tomers have dwin­dled. That’s be­cause in­sur­ers have faced siz­able fi­nan­cial losses on the ex­changes in re­cent years, and have re­sponded by ei­ther hik­ing prices or pulling out of cer­tain mar­kets al­to­gether.

Now, at­ten­tion will turn to ad-

min­is­tra­tive changes un­der­way in Wash­ing­ton de­signed to sta­bi­lize the ex­changes by pre­vent­ing more in­surer de­fec­tions.

The open-en­roll­ment pe­riod to sign up for in­sur­ance for 2018 is slated to start this fall, but in­sur­ers are mak­ing de­ci­sions now about whether to par­tic­i­pate. What kinds of plans will be avail­able and how much they will cost will de­pend on a few key de­ci­sions by in­sur­ers and reg­u­la­tors in the com­ing weeks.

Will I have plans to choose from?

It de­pends on where you live. Choices are dwin­dling, but chances are at least one in­surer will sell in your mar­ket. That com­pany may of­fer sev­eral plans.

Gen­er­ally, big ci­ties will have more choices than ru­ral ar­eas where there may not be enough cus­tomers to at­tract in­sur­ers.

As of now, there are 16 coun­ties in a re­gion of Ten­nessee around Knoxville that have no in­sur­ers com­mit­ted to sell cov­er­age on the ex­change next year. About a third of the na­tion’s 3,100 coun­ties are down to just one in­surer.

In­sur­ers have been pulling back, and more are ex­pected to leave, but health care re­searchers are not pre­dict­ing mass de­fec­tions.

“For most con­sumers, (2018) will look a lot like ’17,” said Dan Men­del­son, pres­i­dent of the con­sult­ing firm Avalere.

Cus­tomers can try to find cov­er­age out­side their ex­change, but then they won’t be able to use tax cred­its to help pay the bills, which may be par­tic­u­larly painful since many mar­kets have seen prices soar.

Are there fixes in store?

Last month, the Health and Hu­man Ser­vices De- part­ment, which runs ex­changes in many states, pro­posed some ad­just­ments to try to sta­bi­lize these mar­ket­places.

For ex­am­ple, in­sur­ers want greater scru­tiny of peo­ple who sign up for cov­er­age out­side of the ope­nen­roll­ment pe­riod. Cus­tomers are sup­posed to be al­lowed to do so only if they have a life-chang­ing event like the birth of a child, a mar­riage, or the loss of a job that pro­vided cov­er­age, but in­sur­ers have found that peo­ple are just wait­ing to sign up when they need care.

An­other pro­posed ad­just­ment would let in­sur­ers de­sign cheaper plans tai­lored to younger peo­ple who may not need lots of health care but want to be pro­tected in the event of a big in­jury or sick­ness. That could be very help­ful, be­cause in­sur­ers say they have strug­gled to at­tract younger and health­ier cus­tomers to the mar­ket­places to bal­ance out the claims they pay from those who use their cov­er­age.

Those changes are ex­pected to be fi­nal­ized in the next month or so.

When will in­sur­ers make their de­ci­sions on 2018?

Some have said they want to see the fi­nal ver­sion of the pro­posed fed­eral ad­just­ments be­fore de­cid­ing where and what kinds of cov­er­age they will of­fer.

But in­sur­ers gen­er­ally have to de­cide by this spring whether they will par­tic­i­pate in or­der to leave enough time for reg­u­la­tory ap­provals and mar­ket­ing be­fore en­roll­ment starts next fall.

Aetna, the na­tion’s third largest in­surer, has set an April 1 dead­line for de­cid­ing on 2018. The com­pany has al­ready pared its mar­ket­place par­tic­i­pa­tion down to four states this year from 15 be­cause of heavy fi­nan­cial losses.

Cus­tomers won’t know for cer­tain who is sell­ing on their ex­changes un­til early next fall. While in­sur­ers have to ap­ply to sell cov­er­age on their ex­changes gen­er­ally by late spring or early sum­mer, they can drop out later.

Is the Af­ford­able Care Act “im­plod­ing,” as Pres­i­dent Trump has said on Twit­ter?

No. The mar­ket­places are not ex­pected to dis­solve next year, even though choices have dwin­dled.

While there’s de­bate over the law’s tax bur­dens and its im­pact on gov­ern­ment bud­gets, the fed­eral plan has cov­ered more than 20 mil­lion peo­ple.

About 11 mil­lion are cov­ered through an ex­pan­sion of Med­i­caid, the health pro­gram de­signed to help poor Amer­i­cans. An­other 12 mil­lion buy pri­vate in­sur­ance through the law’s mar­ket­places, most with help from sub­si­dies based on in­come.

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