‘Death by a thousand cuts’: Despite Trump changes, health insurance coverage options remain

Oct. 14--Several moves against the Affordable Care Act late this week by the Trump administration brought opposition from many health care consumer groups, as well as insurance and medical providers.

While they warn the order to stop paying cost-sharing subsidies to insurers may have devastating long-term consequences, consumer advocates stress the ACA, or Obamacare, remains intact and financial assistance is in place.

"We want to assure consumers that the announcements do not change their coverage options for 2018," said Lou Ann Jeremko, executive director of Consumer Health Coalition in Pittsburgh.

The coalition provides enrollment help for those seeking policies through healthcare.gov, the federal marketplace

"Consumers who are uninsured, or those who need to renew their coverage, should do so during the upcoming open enrollment period, Nov. 1 through

Dec. 15," Jeremko said.

The enrollment period is about half as long as in past years, and the Trump administration cut funding to market the program, leaving many consumers wondering, Jeremko said.

"Regardless of what they have heard, as of today, the marketplace and the Medicaid expansion are still available," Jeremko said.

The administration's actions this week are just the latest in a series of swipes at Obamacare, Jeremko said.

'Death by a

thousand cuts'

"It's part of what I call 'death by a thousand cuts' that the government has put on this," Jeremko said.

The cuts already are taking their toll. Questions about the federal government's future actions has helped fuel an expected spike in premiums by up to 25 percent when the marketplace opens Nov. 1, Antoinette Kraus of the Pennsylvania Healthcare Access Network says.

Kraus said Pennsylvanians received $214 million in cost-sharing reductions last year.

"The uncertainty causes the insurance companies to be nervous," Kraus said. "They have to worry if the money is going to be there to offset some of the significant costs the ACA has already allowed. We really are encouraging folks in (Washington) D.C. to look at how we can stabilize the market."

Representatives of Highmark Blue Cross Blue Shield echoed Kraus' concerns.

Premiums for Highmark products will go up between 10 percent and 25 percent for 2018, said Mark Naze, vice president of market strategy and operations. The larger increases will primarily affect policies that were less expansive, he said.

"We are trying to catch them up because there is a lot of uncertainty in the heath care market," Naze said, citing the cost-sharing subsidies and questions about enforcement of the individual mandate, requiring everyone to purchase health insurance.

Mandate unlikely

to be enforced

Those who don't buy insurance are subject to fines, but the administration and Republican-controlled Congress have suggested it will not be enforced.

"The individual mandate encourages people to buy coverage -- even healthy people," Naze said. "When that mandate is pulled away, what we have left is people who are buying insurance who are sicker. It costs more to take care of them."

Currently, about 1 percent Highmark members account for about 35 percent of health care costs paid by the insurer, Naze said.

Highmark spokesman Aaron Billger said answers about the mandate and subsidies could help insurance companies reduce premiums.

"We are advocating for what we consider to be a stable marketplace," he said.

Billger is quick to add that the Highmark is a nonprofit corporation.

"This is a community of members that uses a lot of health care dollars," Billger said.

"It's not like we are making a lot of money off of these products."

Spike in premiums could be huge

Andy Carter, the president and CEO of The Hospital and Healthsystem Association of Pennsylvania, said in a statement Friday the subsidies Trump ordered eliminated help lower-income individuals secure health insurance. He says more than half a million Pennsylvanians could see their insurance premiums spike by more than 20 percent during 2018.

He's asking Congress to take swift action to protect people from the increases and help support a competitive insurance market.

President Donald Trump said Friday the subsidies are "making the insurance companies rich," but Kraus said the money helps vulnerable populations.

"Cost-sharing subsidies are not bailouts for insurance companies," Kraus said. "They are what allow working families to access affordable health care.

"Stopping the CSR payments would immediately undercut the individual market's continued progress towards financial health and stability by forcing insurers to cover the upfront costs of paying CSRs, leading to higher premiums and potentially even their departure from the marketplace."

She cites a Congressional Budget Office report that found ending cost-sharing subsidies would result in one million more Americans without insurance by next year alone.

The American Medical Association also opposes the action.

"This most recent action by the administration creates still more uncertainty in the ACA marketplace just as the abbreviated open enrollment period is about to begin, further undermining the law and threatening access to meaningful health insurance coverage for millions of Americans," AMA President Dr. David O. Barbe said. "Our patients will ultimately pay the price.

"We urge Congress to accelerate its efforts to reinstate these payments before further damage is done."

Randy Griffith covers health care for The Tribune-Democrat. Follow him on Twitter @photogriffer57.

Randy Griffith is a multimedia reporter for The Tribune-Democrat. He can be reached at 532-5057. Follow him on Twitter @PhotoGriffer57.

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