Quick impact looms in repeal

If the Senate votes for even a partial rollback, insurers could begin backing out.

Health insurers have filed their proposed plans for 2018, and the Republican-led efforts to pass a federal health reform bill appear stalled. But plenty of change could still lie ahead for Colorado’s insurance market this year, depending on critical federal decisions.

The first decision could come as early as next week, when U.S. Senate Majority Leader Mitch McConnell has vowed to bring a partial repeal of the Affordable Care Act, also known as Obamacare, up for a vote. The vote appears likely to fail, but, if it passes, health wonks say it could have an immediate impact on Colorado’s individual insurance market.

That’s because — even though the repeal wouldn’t take effect until 2020 — insurers could begin backing out of the state this year in response to any policy changes at the federal level.

“That would greatly destabilize the individual market or throw it into a death spiral,” said Adam Fox, a spokesman for the Colorado Consumer Health Initiative.

The changes would at first only impact the individual market — where people buy health plans on their own and which has been most subject to queasiness from the rollercoaster of federal health laws over the last several years. The individual market covers about 7 or 8 percent of Coloradans, but that’s still hundreds of thousands of people.

The repeal, as proposed in the Senate, would end in 2020 the tax credits that help many people in the individual market pay for their premiums. Also that year, it would end the extra subsidies that help low-income people pay for deductibles and other out-ofpocket costs.

But insurers, knowing that major changes are coming to the individual market, could begin pulling back this year — or asking to charge even higher rates.

Insurers on the individual market in Colorado are already proposing an average rate hike of 27 percent for 2018. But the state also allowed insurers to submit a separate set of rates for an alternate scenario where the lowincome deductible subsidies are not funded.

In addition to the repeal bill, President Donald Trump this week suggested he might pull funding for those subsidies.

State Insurance Commissioner Marguerite Sala- zar would not say last week what those alternate 2018 rates are, but she said they are higher than the currently proposed rates.

“Those are hopefully never going to be made public because we hope to never have to use them,” she said.

Insurers also have until September to pull back from offering plans in some counties. Vincent Plymell, a spokesman for the state Division of Insurance, said insurers cannot exit the state entirely for 2018 at this point because they have to provide notice 180 days in advance. But they can scale back their footprint — which could still leave people in some counties without any options in the Affordable Care Act marketplace.

“When you start tinkering with any one of those factors,” Salazar said, “it really upsets the market.”