Obamacare choices increase, but so do costs
Middle-class is hardest hit under rate hikes that could top 45 percent
Dire political predictions that insurers would flee the individual market and consumers would have fewer choices in 2018 — in essence killing off the Affordable Care Act — do not appear to have come true.
But the coming year could be nightmarish for middle-class and higher earners who could face rate hikes as high as 45 percent in the Houston area.
Those who sign up next week on the federal exchange actually will see more available plans for next year. The number of insurers is rising to four, from three, and they will be offering 34 plans, up from 26, according to a preview of plan choices and prices made public Wednesday at healthcare.gov.
That comes as welcome news to lower-income enrollees now in a better position to comparison shop and take advantage of the federal subsidies to help lower premiums and outof-pocket costs.
Higher earners, though, could absorb the full brunt of price hikes as to compensate for the loss of a key federal payment and other market uncertainties. Many health policy watchers worry that those people could ultimately be priced
out and become uninsured.
Enrollment for 2018 on the federal exchange opens next Wednesday and will run through Dec. 15, half the time of previous years.
Community Health Choice, one of the four insurers offering plans on the exchange in the Houston area, confirmed Wednesday its average rate hike will be 45 percent, showing up mostly in silver plans. When the company filed its rate requests in June it had asked for 16.4 percent but has since revised its filings four times in past four months based on feedback and requests from the federal government.
Molina Health Care said Wednesday its final rate increase for Houston is an average of 38 percent, less than the 43 percent statewide, which is nearly double what it had originally asked for last summer.
Blue Cross and Blue Shield of Texas has not commented on its final rate increase request nor does the Center for Medicare and Medicaid Services website reflect those rates yet. It appears, however, that the rates on the preview Wednesday are mostly consistent with the roughly 24 percent increase request submitted in June. Trump’s threat
Many insurers have scrambled to recalculate filings after President Donald Trump made good on his threat to end the federal payments to insurers called cost-sharing reductions that help lower income people with out-of-pocket expenses such as deductibles.
It is estimated those payments would total about $9 billion next year. Since they are still part of the law those who qualify will continue to receive them next year.
The issue, however, is who pays for them.
Insurers will eat the cost for the remaining three months of 2017. But on Jan. 1, when the new plans go into effect, the shortfall will be passed on to consumers in the form of much higher premium costs. If an enrollee’s income is low enough to qualify for either the cost-sharing reduction assistance or the betterknown tax credit, they will be mostly insulated from steep rate hikes.
Ken Janda, CEO of Community Health Choice, said his company, like insurers across the country, have loaded most of their 2018 rate increases onto silver plans under recent instructions from the federal government because current law calculates the amount of subsidy an enrollee receives in part based on a benchmark silver plan.
Janda admits it is a kind of an end-run insurers are using to make sure that if silver plans see big rate hikes they will also carry larger subsidies.
“We didn’t want to do it that way,” he said, adding that Community Health Choice asked to lower its rate filing but the Centers for Medicare and Medicaid Services denied it. Janda said his company will offer a 10 percent rate credit for customers who answer health-assessment questions during enrollment.
Still, the strategy may not help everyone.
“The middle class is the big loser as we continue to see the burden of high premiums cast upon individuals and families that don’t have group insurance and don’t receive subsidies,” said Jason Bohmann, a Houston insurance broker.
The newcomer to the Houston exchange market is Ambetter from Superior Health, a subsidiary of Centene Corp.
Ambetter has listed 14 plans, each the exclusive provider organization. That type of plan is similar to a health maintenance organization, but it does not allow a customer to go outside its network.
As in years past, most of the offerings on the exchange are HMOs.
The 34 plans being offered locally include seven bronze plans, 19 silver plans and eight gold plans, according to the preview. The preview offers only a snapshot, and exact prices will depend on individual circumstances and location.
The average 2018 fullprice individual bronze plan, without subsidy, is $344, up from the average of $316 per month. In both years there were seven bronze plans available. Silver plans increase
The number of silver plans is up from 11 in 2017. The average price for an individual silver plan in Houston rose to $430 per month without subsidy, up from $362. There are also eight gold plans for 2018, the same number as 2017. Their average price, without subsidy, for 2018 is $487, rising an average of $68.
The amount of deductible continues to vary widely. Some higher priced plans carry no deductible while an Ambetter silver has a $7,350 deductible.
Katy Caldwell, executive director of Legacy Community Health Services in Houston, is dismayed by the confusion that surrounds the health care law. She said many believe it has already been dismantled.
The Trump administration recently slashed 90 percent of the advertising budget to announce the enrollment season. It also has severely reduced the amount of grants given to community organizations to help with outreach.
To counteract what she and others call internal sabotage, Caldwell’s organization has allocated $25,000 to radio and digital advertising to make sure people know the law is still in effect.
She is bracing for lower enrollment.
“We will have a lot more people uninsured,” she said.