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, 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.

 ?? J. SCOTT APPLEWHITE/ASSOCIATED PRESS ?? Rate hikes are set to ease this year, but Sen. Charles E. Schumer (N.Y.) and other Democrats aren’t touting that as a success, instead sticking to this script: Republican­s are driving up prices. “Period.”
J. SCOTT APPLEWHITE/ASSOCIATED PRESS Rate hikes are set to ease this year, but Sen. Charles E. Schumer (N.Y.) and other Democrats aren’t touting that as a success, instead sticking to this script: Republican­s are driving up prices. “Period.”

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