The Washington Post
Democrats no longer cheer Obamacare’s bright spots
Congress’s official scorekeeper says Obamacare premiums will rise more slowly next year and the marketplaces will be stable in most parts of the country. But don’t expect Republicans — or surprisingly, even Democrats — to be doing any wild cheering.
In a dramatic shift that still leaves my head spinning, Affordable Care Act plans have lost their most ardent political defenders, as Democrats have switched from playing down premium increases to advertising them as the GOP’s fault. And Republicans are now reluctant to talk about the law at all, aware they reneged on their long-standing promises to fully repeal it.
There are still rough times ahead for the marketplaces, partly due to Republican actions that are driving up premiums even more than they would otherwise rise. There are also faint signs that the marketplace situation is somewhat improving. But it’s unlikely that either Democrats or Republicans will be talking about the bright spots.
On Wednesday, top officials with the Blue Cross Blue Shield Association — whose insurers have the strongest presence in the ACA marketplaces — told reporters that rate increases in 2019 should be somewhat lower than in years past. Hours later, the Congressional Budget Office offered a similar analysis, projecting that the average premium for a mid-level marketplace plan will increase by about 15 percent next year, compared with an average 34 percent increase this year. The CBO expects premiums for those covered by Obamacare to increase an average of 7 percent annually between 2019 and 2028.
Senate Minority Leader Charles E. Schumer (D-N.Y.) reacted swiftly — but it wasn’t to applaud the slower rate increases. Instead, he said the CBO report confirms “the Trump-GOP sabotage of our health-care system is causing premiums to rise for millions of Americans — period.”
Until Donald Trump was elected president 18 months ago, Democrats were quick to defend ACA insurance plans, praising their broad coverage and noting the wide availability of subsidies to lower costs for Americans seeking access to health coverage. When news of big rate hikes hit over the past few years, Democrats mostly looked the other way, wary of criticizing President Barack Obama’s signature domestic initiative. But no longer. The reality is, Republicans leading both chambers of Congress and the White House have acted in ways that could trigger the rise of premiums. They’ve repealed the law’s individual mandate, paving the way for healthier people to leave the marketplaces and leave sicker, more expensive patients behind. They’re working to expand leaner plans exempt from ACA coverage requirements. And they haven’t found a way to pay additional subsidies to defray extra plan costs for the lowest-income customers.
It’s also true that ACA marketplace problems existed before the GOP took the White House. Premium increases were so large in 2016 that many Democrats were forced to admit that changes to the ACA were needed.
Now, Democrats seem to have wholly and enthusiastically assumed the Obamacare gloomand-doom mantle, jumping on any chances to spread negative marketplace news far and wide. They’re the ones, not Republicans, seeking to leverage the law to their advantage in the upcoming midterm elections, which will take place five days into the 2019 open enrollment season.
On Wednesday, the Democratic Senatorial Campaign Committee blasted out its latest news release on what it’s terming “sabotage” by Republicans on health care. And Sen. Chris Murphy (D-Conn.) took to the Senate floor to rail against how Republicans have been approaching ACA coverage.
“Starting in January of 2017 . . . the president, and often with the help of this Republican Congress, has engaged in a very deliberate, very purposeful campaign of sabotage to the American health-care system,” Murphy said.
Undergirding the political messaging wars, four states have announced marketplace insurers’ initial proposed rates for the 2019 enrollment period. Average hikes range from 9 percent in Vermont to 29 percent in Maryland, according to an analysis by Charles Gaba on his website, ACAsignups.net. Requests span a broad range, especially in Virginia, where CareFirst is seeking a 27 percent rate hike for its HMO plans but a 64 percent hike for its PPO plans.
“There is no average, but I think if you were to come up with an average, it would be in the low teens nationwide,” Kris Haltmeyer, Blue Cross Blue Shield Association’s vice president of legislative and regulatory policy, told reporters Wednesday.
There’s actually evidence that marketplace plans are regaining some profitability. Their medical loss ratios, the share of premiums paid out as claims, have recently started to improve, and their gross margins per member are rising, according to an analysis last week from the Kaiser Family Foundation.
But, like lawmakers, Blue Cross Blue Shield officials played down signs of improvement, saying things still look deeply uncertain for their members. “Even though plans may be making a profit, that’s modest,” said Justine Handelman, senior vice president of the association’s policy office. “In most cases, about 1 to 2 percent is what you see on average across the plans.”
They’re dividing the blame for premium hikes between the high medical costs of marketplace customers, a problem from the beginning, and congressional Republicans’ move to repeal the individual mandate to buy health insurance. Haltmeyer said he’s hoping the Trump administration “doesn’t do anything to destabilize the market as we go toward this next enrollment period.”
The Blue Cross Blue Shield officials said they feel the administration has made a few positive moves to assist marketplace enrollment, such as making it easier for individual insurers and brokers to directly enroll people in coverage.
But there are a slew of other actions that deeply frustrate them, most prominently the failure of Congress to reimburse insurers for the extra costsharing discounts or fund a reinsurance pool that helps protect insurers against heavy losses.
Because those initiatives appear dead in Congress — at least for now — Haltmeyer and Handelman said they’re hopeful states will step in and create their own reinsurance pools. So far, Alaska, Oregon and Minnesota have obtained permission from the federal government to pay for the highest-cost customers with reinsurance pools, and Oklahoma, Wisconsin and Maryland have passed similar legislation.
“We want to see a stable market where we can make sure everyone has access to coverage, and that’s why we think it’s so important at this juncture for states to take control back,” Handelman said.