As Trump Attacks the Federal Health Law, Some States Try to Shore it Up
But this year, many of those untethered workers may be wishing they lived anywhere but here. Residents of
Premiums are also substantially higher than average, although not as high as in
Nationwide, premiums for average-priced policies -- according to a
The underlying cause of the rate hikes is clear: efforts last year by the Trump administration and its allies in
"It all added up to chaos and uncertainty in the insurance market," said
This year, a handful of Democratic-led states are gearing up to curb further rate hikes by enacting laws and adopting insurance regulations designed to shore up the traditional insurance industry and restore parts of the ACA, known as Obamacare.
At the same time, at least one Republican-leaning state has moved to further unravel the federal health law by encouraging insurance companies to offer cheap policies with fewer benefits. Others are expected to follow.
Both red and blue states are reacting to a series of federal actions.
The federal tax overhaul enacted in December repealed the individual mandate, which required everybody to have health insurance or pay a financial penalty. The requirement was designed to ensure that healthy people signed up for insurance so that premiums for everyone remained affordable.
Two months earlier, President
Around the same time, Trump also cut the health exchange enrollment period in half. And earlier in the year, he slashed the marketing budget for federal exchanges to further damage the health law by curtailing enrollment.
This year, both branches of government promise further attacks on the health law, including final actions on two administration proposals. One would encourage insurers to offer short-term policies with variable copays and deductibles, and the other would allow people to form groups to create so-called association health plans with cheap premiums and limited benefits.
States Respond
In
Going in the opposite direction,
Taking a different tack -- one that has been endorsed by members of both political parties --
Under the health law, the federal government can reimburse states for any money spent on reinsurance programs that results in lower premiums, and thus reduced federal tax subsidies, as long as the reimbursements do not exceed federal savings.
In
By encouraging more people to enroll, states can improve the odds that their insurance markets will stabilize and premiums will remain affordable.
"Consumers are still confused about health insurance subsidies, and they're hearing a lot of bad news about the ACA," said
It's too early to know how many other states will move this year to fill the policy gaps in the tattered Affordable Care Act. But consumer advocates are urging lawmakers and governors to act sooner rather than later.
"States need to prepare now if their initiatives are going to have the desired effect," Lueck said. If states want to stabilize the insurance industry by establishing individual mandates or reinsurance programs, they need to have their policies in place before spring and summer, when companies are required to file preliminary rates for 2019, she said.
For states that want to follow
But there's another approach states can take at any time to protect their traditional insurance markets from the continued uncertainty created by attacks on the ACA from
Once federal agencies finalize rules allowing cheaper, substandard health policies, states can prohibit those policies from being sold within their borders unless they comply with ACA consumer protections, according to a recent article by a group of consumer advocates in the policy journal Health Affairs.
Unsubsidized Consumers
Before the Affordable Care Act took effect in 2014, people who were self-employed, between jobs or working part time and were not offered employer-sponsored health plans typically had to pay the highest prices for health coverage because insurers considered the relatively small pool of individuals riskier than larger groups.
Many people who faced high-priced individual insurance policies took their chances and went without coverage. Others opted for cheaper plans with high out-of-pocket expenses and limited benefits.
For this group, the ACA's consumer protections were a huge boon. Confident they could find affordable health insurance, many workers were able to strike out on their own for the first time.
Insurers were prohibited from refusing coverage to people with pre-existing conditions or charging people higher premiums because of their medical history. And although individual market premiums still tended to be higher than group plans, rates and coverage improved in the first four years after the federal health law took effect.
But last year's revisions to the law may have changed all that.
As a result, many states can be expected to take action this year to protect this group of consumers from unreasonably high insurance premiums, said
The result, he said, will be even greater disparities than already exist between states in the number of people who can afford quality health care coverage.
In fact, the Trump administration's tactics are likely to bolster the overall proportion of Americans enrolled in Medicaid and federally subsidized exchange policies, said
Left out will be people not covered by employer-sponsored insurance and with incomes too high to qualify for Medicaid or federal exchange subsidies. Nationwide, about 22 million people purchase insurance in the individual market, according to Kaiser. About 43 percent of them have incomes too high to qualify for federal tax subsidies on the exchange.
But even if they win the case and the state orders Optima to issue refunds, they and the others in their group won't personally benefit. The money would go to a regional insurance pool and ultimately would be deducted from future premiums for all policies.
Stovall, Dixon and Quist, all of whom had incomes just above the federal limit, could not afford their 2018 insurance premiums, roughly
Dixon, a self-employed software developer, said he and his family moved from
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