Las Vegas Review-Journal (Sunday)
ACA enrollment underway; confusion reigns
Despite rhetoric, health care law remains in effect
MACON, Ga. — David Branch knew that his job, helping people sign up for Obamacare, would be harder this year. But Branch didn’t fully realize the scope of his challenge until a group that he approached with his flyers insisted that the Affordable Care Act had been repealed.
“They said, ‘Why are you guys here? Obamacare is done,’” Branch recalled last month as he finished a training session here.
In fact, the Affordable Care Act has survived blow after blow since President Donald Trump took office in January, including repeated attempts by Congress to repeal it. But as the fifth open enrollment period started Wednesday, the law was reeling from continued attacks by Trump that have sown confusion and anxiety among the roughly 10 million Americans with coverage through its insurance marketplaces and millions more who remain uninsured.
Most recently, Trump announced plans to cut off subsidies that reimburse insurance companies for assistance they are required to provide to low-income customers who struggle with co-payments and deductibles. The cuts resulted in a crazy quilt of premiums for 2018 that differs radically from the pattern of the last four years, which will upend expectations of consumers in many states.
And the administration’s sharp cuts to advertising for the law’s open enrollment period and to groups that employ enrollment “navigators” like Branch have almost certainly limited public awareness that now is the time to enroll. Those who have heard Trump’s message that insurance premiums are way up may not realize that the subsidies that help low- and middle-income Americans pay those premiums will rise as well.
The enrollment period for the federal marketplace has been cut in half, to 45 days, with hardly any publicity by federal officials. No one is sure how well government call centers and computer systems will handle the expected surge of applications leading up to the Dec. 15 deadline for people to enroll through HealthCare.gov.
In Washington and across the nation, supporters of the law are doing what they can to combat misperceptions.
“Consumers are unclear whether the marketplaces still exist, whether they still have an obligation to get coverage, whether the mandate exists, whether they can get financial assistance,” said Kelley Turek, a policy analyst at America’s Health Insurance Plans, a trade group. “Our message is: Come back. The market-
places are still here.”
Here in Georgia, what had been the largest navigator group, Insure Georgia, lost 86 percent of its $2.3 million federal grant and had to lay off half its staff, leaving Branch and 10 other counselors to provide enrollment assistance for all 159 counties in the state. Humana is leaving the insurance marketplace here, and while three other insurers will remain, all but 10 counties will have a single company selling coverage for next year. Rates for popular silver-level “benchmark” plans are rising by 47 percent on average here, according to the Department of Health and Human Services, although most customers will qualify for subsidies that will grow by a similar amount. The department found that premiums for benchmark plans are increasing by 37 percent nationwide, compared with 24 percent last year.
Other types of plans may be less expensive, because to compensate for the funds they will lose now that Trump has ended the cost-sharing payments, insurers have generally raised the price of silver plans more than those in the bronze, gold and platinum categories. As a result, some gold plans will now be less expensive than some silver plans, even though gold plans cover more of the costs of a typical consumer.
Sorting through these complications will be difficult for many consumers.
At a Halloween “safety expo” at Coliseum Medical Centers here Oct. 28, several hundred parents and children filed past an Insure Georgia table by the front door, where Amber Higgins, another navigator, asked over and over, “Do y’all have health insurance? You know anyone who’s doing without it?”
“My niece who just moved here from Ohio,” said one woman, taking a flyer.
“My sister in Texas,” said another.
“Me,” said yet another woman, scanning the income requirements for receiving subsidies, which Higgins had placed in a frame.
The response was not surprising. Georgia has the nation’s fourth-highest number of uninsured residents, after Texas, California and Florida. In some of the state’s rural counties, enrollment under the Affordable Care Act dropped by as much as 36 percent this year, according to a new report, which pointed to the diminishing choice of insurers in rural areas as a likely reason.
Briana Zoellick, 26, told Higgins she had checked HealthCare. gov when it started allowing people to preview their options last week and was astonished to learn that her family’s subsidy would be a lot bigger next year even though their income has risen. Zoellick, a medical assistant and mother of two, said she and her husband, a graphic designer, canceled their coverage earlier this year because they could not afford their portion of the premium, about $140 a month.
Next year, she has learned, their subsidy will rise to more than $800, from $650 — “incredible,” she said — and their share will be less than before.
Yet Zoellick said her husband remained wary of signing up because of everything he had heard about Trump ending the payments to insurers. Many customers are mistakenly assuming that what he is blocking is premium subsidies, which are separate and not affected by Trump’s action.
“He was like, ‘I don’t know if that’s going to actually happen because of what Trump’s doing,’” Zoellick said, referring to their higher subsidy.
The California marketplace, run by an independent state agency, is spending $111 million on advertising, more than 10 times as much as the federal government intends to spend for the entire country. The New York marketplace, run by the state Health Department, is spending $15 million.
In some states that run their own insurance exchanges, consumers will have more time to sign up. The deadline is Jan. 14 in Minnesota, Jan. 15 in Washington state and Jan. 31 in California and New York.
While many consumers will have fewer choices and will face higher premiums next year, the situation varies greatly from state to state.
In Tulsa, Okla., seven health plans will be available, all from one company. For the most popular plans, the average premium for a 35-year-old will be about $560 a month, according to HealthCare. gov. In Phoenix, Ariz., consumers will have a choice of five plans, all from one company. For the two popular silver plans, premiums for a 35-year-old average $470 a month.
Mike Kreidler, the insurance commissioner in Washington state, approved rate increases averaging 36 percent last month, and he attributed 10 percentage points of the increase to Trump’s decision to cut off the subsidies known as cost-sharing reduction payments.
“I fear that many will go uninsured,” Kreidler said, while noting that some plans would not be affected by the president’s action.