Some ACA premiums fall, others spike; enrollment keeps surging

By Ariel Hart – The Atlanta Journal-Constitution

Tyrone Jenkins sat in his insurance agent’s office on Friday, relieved about his health insurance. After all the upheaval and news over skyrocketing Obamacare premiums, Jenkins will actually see his coverage costs plummet next year. He’ll pay less than half in 2018 what he did in 2017 for similar coverage. How can this be?

Jenkins doesn’t like the answer. Thanks to decisions made in Washington in recent months, it’s possible because a new and costly inequality has opened up between some policyholders. The cancellation of one subsidy brought in another that benefits people in Jenkins’ position — while leaving other policyholders to take a bigger hit, some to the point they can no longer afford coverage.

And Jenkins the taxpayer will be subsidizing this situation even more, along with other Americans. “In some stuff it’s kind of frustration,” Jenkins, a forklift driver who lives in Lee County, said of Washington’s management of health care. Jenkins said he “really” likes his plan, but he really doesn’t like that other people’s premiums are skyrocketing at the same time. And if it adds to government debt, he thinks policymakers should consider the burden on future taxpayers: “It’s the younger generation that’s coming up.”

Open enrollment for the Affordable Care Act, also known as Obamacare, is now three weeks underway. Enrollment is continuing at a ferocious clip, and situations such as Jenkins’ may be one reason why. It partly gets back to a controversial decision by President Donald Trump. For months Trump threatened to cancel “cost-sharing reduction” subsidies, and just before enrollment opened he did.

The nonpartisan Congressional Budget Office (CBO) predicted that canceling those subsidies — which went to insurers so they in turn could lower costs for lower-income customers — would on average add 20 percent to premiums; that many people would drop coverage; and that companies would pull out of some markets. That did happen and has gotten much publicity.

TIPS FOR ENROLLING: AJC FAQ on Obamacare Open Enrollment

But the CBO did not predict that everyone would suffer. The CBO also predicted that other people would get such great deals that they’d opt for new coverage. People who couldn’t afford the best plans before now could afford them. That appears to be happening, too.

For basic health coverage in 2017, Jenkins’ plan cost him $102 a month (after cost-sharing reductions made it affordable). In 2018, those subsidies are gone. Now, different subsidies come into play, and because of how the law works, after Trump’s executive order, they’re bigger. So this year, that same type of coverage will cost Jenkins just $38. It’s such a dramatic discount that he’s opting to add dental and vision, for a total of $99.

None of that would be a surprise to the CBO’s analysts. They predicted that overall, the decision to cancel the cost-sharing reduction subsidies — allowing the other, bigger subsidies to kick in —would add $194 billion to the deficit over 10 years.

Dan McBrayer, an agent several counties away from Jenkins, doesn’t think much of these developments. “The people that’s getting a tax credit are getting a bigger tax credit,” he said. “The people that aren’t are getting a bigger bill.” McBrayer concluded, “Quite frankly, this thing is such a train wreck.” McBrayer has a lot of clients who fall above the subsidy threshold of making about $48,000 for a single person’s household, and they are getting clobbered with the full force of massive premium hikes. Many of them feel they have to drop insurance, he said.

On the other end of the spectrum, Kirk Lyman-Barner, Jenkins’ agent, has a lot of clients who make less money and qualify for strong subsidies. Even as the insurance companies raised rates this year, the subsidies came in even stronger to make the consumer’s cost low. Some are even getting premiums of zero this year, mostly older people. “Every single one of them is better off except for the folks that don’t get the benefit,” Lyman Barner said. “For those folks it really breaks my heart. Because it was unnecessary.” Jenkins’ cheaper plan is not a fluke.

An analysis calculated for The Atlanta Journal-Constitution by researchers for the nonprofit Kaiser Family Foundation showed the phenomenon holds. According to those figures, a 40-year-old ACA policyholder in Atlanta making $24,000 a year would see a dramatic price drop for the lowest-cost “gold” plan. In 2017, that policyholder would be paying about $235 per month. But in 2018, that plan would cost that person just $175.

The plan wouldn’t cost less to provide. The insurance company on average hiked the overall price from $380 a month to $465. But the policyholder wouldn’t see that increase because taxpayers would take the hit. The formulas are all spelled out in the law.

There is wide agreement that the subsidy set-up is a problem, and some centrist U.S. senators briefly attempted to fix it. That fell apart in the GOP’s renewed attempt to repeal the law at the last minute in September.

Trump has said his decision on the subsidies would force Congress’ hand. In the meantime, critics of the law say blame it, not the president, for  trying to undo what pieces he can.

Bill Custer, a health care finance researcher at Georgia State University, wouldn’t say the decision to cancel the cost-sharing reduction subsidies was good or bad. But he did note the results were predicted. “By canceling these CSRs, the Trump administration has increased taxpayer costs for this coverage, increased the deficit and decreased coverage in general,” he said.

It’s impossible to know whether enrollment this year will surpass last year’s. New figures released by the Trump administration for the second week of enrollment show that in the first 11 days, nearly 1.5 million people signed up for plans, compared with just 1 million people in the first 12 days last year. But the enrollment period will be half as long. This year it ends Dec. 15.

Jenkins is one of those as he buys his plan. He wishes other people could do that too, though, because health is unpredictable and he thinks the need for health insurance is something that ties everyone.

“I’d prefer everybody to be equal,” he said.

Obamacare insurers’ 2018 rate increases to rise even more

Customers of the Obamacare exchange markets in Georgia got bad news this summer when insurers first disclosed the rates they want to charge next year. Not only were double-digit increases on the table — well over 50 percent for some plans — but some insurers flat-out said they might rise even more.

Now the final deadline for rates is approaching. And according to state officials, premiums will indeed rise even more.

“The amended rates are higher than those originally filed with this office,” the state Department of Insurance said in a statement. “While outside actuaries are still reviewing the rates, it appears that in Obamacare’s fifth year, Georgians will experience another double-digit premium increase.”

The final proposals must be done by Sept. 27.

“Oh boy,” said Kirk Lyman-Barner, who sells insurance policies on the Obamacare exchange. He pointed out that for lower-income customers who get subsidies, the burden of higher premiums will fall not on them but on taxpayers because the government will have to fill the gap for poorer customers with subsidies. However, people stop qualifying for subsidies at just $50,000 or so for a family household, so those with higher incomes will be faced with simply paying the whole raised rate.

“It’s very hard on the folks who are not getting a subsidy,” Lyman-Barner said.

Insurers have made no bones about what is to blame: uncertainty in the White House and Congress over basic insurance policy. At least one company, Blue Cross Blue Shield of Georgia, baldly warned the state that it could raise rates even higher than its initial proposals if messaging from Washington did not resolve the issue. So far it has not been resolved.

In fact, just this week as Republican and Democratic senators worked in old-fashioned bipartisanship to take small steps to stabilize the exchange, word leaked that that effort could be upstaged.

A separate effort to revive legislation to repeal and replace Obamacare was yet again under fevered discussion, though as of Friday afternoon it seemed stuck where it was this summer, still just short of the necessary votes to pass.

In July, Georgia’s Department of Insurance released the insurance companies’ first proposals for 2018 rates and coverage areas, which represent the start of negotiations between them and the state. They all came in with major premium increases, but the shocker was Blue Cross, the state’s only statewide insurer on the Obamacare exchange market.

Blue Cross proposed a rate increase averaging 40.6 percent across its policies. The other three companies remaining on the exchange also proposed double-digit increases: 12.4 percent on average for Ambetter, 18.6 percent percent for Alliant and 25 percent for Kaiser Permanente.

Then Blue Cross announced an even more alarming move: For the first time in decades, the company was pulling out of the individual market in metro Atlanta and other urban areas of the state. In documents related to that decision, the insurer warned the state it might pull back even more by the final September deadline — depending on news from Washington.

The company this week did not make public the information on its final filings. It referred questions to the state, and a spokesman for the Insurance Department said there were as yet no updates.

What happens if I miss the deadlines?

There are two important deadlines rapidly approaching. First, for those wanting to have health coverage beginning on January 1, 2014, then they must be enrolled by December 23, 2014. The first month premium is due to the insurance carrier by January 5, 2014.

After December 23, 2014, individual and family plans can be purchased until March 31, 2014 when the open enrollment period ends. For the remainder of the open enrollment period, insureds must be enrolled by the 15th for a start date of the 1st of the following month. For example, if you enroll between December 23, 2013 and January 15, 2014, you will be given a February 1, 2014 start date. If you enroll on January 16th through February 15th, the start date would be March 1.

After enrollment closes, one can only purchase health insurance if there is a life changing event such as the birth or adoption of a child, a marriage or divorce or a loss of coverage from a group plan. Open enrollment will begin again in October when individuals and families can shop for different plans or sign up for the first time.

Application Updates 12/04/13

The clients for whom we sent paper applications have been getting calls and are completing their enrollment.  Tonight I navigated my first online application in which the client was enrolled in a plan that was about half the cost of her previous plan which she had dropped due to affordability  So things are looking up, but we will have to work hard to get everyone in by December 23rd if they want a January 1st start date.  Let me know if you or someone you know needs some help.  We will do our very best to get them enrolled on time.

Blue Cross Blue Shield of Georgia Extends New Policy Acceptance Deadline – Now December 23, 2014

If you have an individual plan with Blue Cross Blue Shield of Georgia you now have up until December 23rd to decide to keep their offer or purchase a plan through the Marketplace.

I’ve had clients who are young and healthy and unable to benefit from the subsidy decide to accept their offer.   I’ve also had clients decide to get a market place plan because the subsidy made it more affordable.

If you or someone you know in Georgia need some help enrolling, give me a call at (229)-389-4575.

Obamacare application updates

The first paper applications we sent in have been received and the clients are receiving calls from the folks processing the forms.  Next they will receive a packet in the mail and after they read their options they can call the toll free number and select the plan of their choice.   Of course, I will be happy to assist them pick the best plan for their situation.

An additional option for enrolling will be announced soon.  The CMS teams managing the website are going to provide the technology to the carriers to allow them to sell subsidized plans.  This will help us get people enrolled before the December 15th deadline for a January 1, 2014 start date.  This is very encouraging.   If you or someone you know in Georgia need some help enrolling, give me a call at (229)-389-4575.