Enrollees, insurers are waiting for Affordable Care Act answers, but uncertainty is what they’re receiving

Aug. 31--For Donna Tanega, the Affordable Care Act is more than a political debate.

It's a discussion of whether her 14-year-old son will have health insurance.

Her son, Evan Payne, is one of 360,000 Virginians relying this year on exchange plans under former President Barack Obama's health care law .

While some enrollees may have sighed in relief when repeal efforts failed, they now face uncertainty over what awaits them when the enrollment season opens Nov. 1.

"What the politicians don't see is they're not helping by fighting over it," said Tanega, who lives in Virginia Beach.

So far, fewer choices, higher prices and confusion look to be in the mix. Insurers, marketplace counselors and "Obamacare" enrollees are all watching and waiting for answers. A key date is Sept. 27, when insurers must sign final contracts to sell 2018 exchange plans and also include rate proposals with their bureaus of insurance.

The market remains volatile, as illustrated by Anthem Blue Cross and Blue Shield's announcement Aug. 11 that the insurer was leaving the Virginia individual market, except for a couple of counties in the far western part of the state.

That leaves Hampton Roads with one provider, Optima Health, and that company's offerings could change as well.

Michael Dudley, president and CEO of Optima Health, said in an emailed statement that Anthem's departure has caused Optima to rethink its strategy.

"When a large health plan like Anthem suddenly leaves the individual product market, the insurance risk of the sizable number of members they leave behind is unknown to the remaining carriers, and this creates an unpredictable situation. From day one, our desire has been to find a way to stay in the ACA exchange," he said, using an acronym for the health care law. "We have been weighing our options and discussing all the pros and cons on a daily basis since Anthem's announcement."

Dudley's statement said Optima is re-evaluating the plan it filed with insurance officials in July and considering reducing the number of markets it proposed serving on the exchange and its the rate structure.

"It's too premature this week to relay our final plan but it is doubtful we'll be able to cover the majority of the state as we had originally hoped," Dudley said.

Insurers are closely watching Congress for any movement that could either harm or stabilize the marketplaces.

If tax credits or subsidies, for instance, were reduced, that would have a significant impact. Sixty percent of "Obamacare" enrollees in Virginia receive a cost-sharing reduction, which pares deductibles, copayments, and coinsurance. About 80 percent receive a tax credit, according to Centers for Medicare & Medicaid Services.

Also at play is the individual mandate, which brings down premiums by compelling healthy people to buy coverage. Will it be repealed? If not, to what degree will it be enforced?

Republicans have cast Anthem's exit from Virginia as a sign of the inevitable collapse of "Obamacare," while Democrats and supporters of the health care law have blamed President Donald Trump and the Republican-controlled Congress for undermining the market.

Currently, five insurance companies have applied to provide plans in Virginia: Optima, Kaiser, Piedmont, Cigna and CareFirst. More regions in Virginia will have only one insurance company offering plans.

Doug Gray, executive director of the Virginia Association of Health Plans, said fewer insurers usually means fewer choices and, sometimes, higher premiums.

Gray said when one company has to cover more people, the pool of sicker, more-costly enrollees gets bigger.

That problem worsens if there's not a strong mandate for people to have insurance. He said this is a time when Congress has an opportunity to stabilize the market before the Sept. 27 deadline. He said the market needs repairs that would last two years, rather than short-term fixes.

A Kaiser Family Foundation analysis of marketplace plans, released in August, looked at premium increases based on preliminary filings with insurance bureaus.

Those numbers are subject to change, especially since Anthem left the Virginia market, but the analysis focused on the second-lowest silver plan, which is one of the most-popular plans on the marketplace.

For a 40-year-old nonsmoker making $30,000 a year, without a tax credit, premiums ranged from $244 in Detroit to $631 in Wilmington, Del.

In Virginia, the analysis looked at the Richmond market and predicted a 33 percent increase for that plan, with premiums increasing from $296 in 2017 to $394. But for those who have a tax credit, the cost would go down slightly.

Jill Hanken is a health attorney for the Virginia Poverty Law Center, an organization that runs Enroll Virginia, a federally funded health navigator system, to help people find affordable insurance. The group is trying to stay abreast of any changes in insurers and legislative action.

"We're doing our work when there's a lot of uncertainty, both in Virginia and in D.C.," Hanken said.

She said her 30 "certified navigators" are already fielding calls from current enrollees across the state.

"People have questions and concerns, and that's appropriate right now," Hanken said.

Those currently covered by Anthem, for instance, will need to make another selection and determine whether their doctors and health care providers are part of that plan's network.

This year's enrollment window is the shortest ever: Nov. 1 through Dec. 15.

"That alone will create a lot of demand on our navigators," Hanken said.

She advises enrollees to keep an eye out for any correspondence from insurers, both through postal mailings and email.

People should talk to their doctors and other health care providers about what health networks they belong to, and know what prescription drugs they need.

"It's not too early to start thinking about it," she said.

The federal website, HealthCare.gov, will have choices listed sometime in October, before the enrollment window opens. Even if there is only one insurance provider in an area, that insurer would likely have various plans.

For Tanega, a 49-year-old bookkeeper, any increase in premiums and deductibles would be a hardship. When she first enrolled in an "Obamacare" plan about three years ago, she was able to afford a plan for herself.

Her son qualified for FAMIS, a Virginia health insurance program for children.

She had a bookkeeping job with a temporary company that didn't provide benefits. But at one point, she made too much for her son to continue on FAMIS, so she added her son to her plan.

The premiums and deductibles went up so sharply, she dropped coverage for herself but kept her son on a plan. She pays for her own doctor's visits and reached out to pharmaceutical companies to find help in paying for prescription drugs.

"I refuse to go to the doctor if I can't afford it," Tanega said. "I make sure my son is covered, I take care of my child before myself, that's the situation I'm in."

Now she's anxiously awaiting what next year's market will look like, but gets frustrated listening to the congressional debate.

"Politicians are making it worse."

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