Florida ACA enrollment less predictable this year

Oct. 21--The conceivable threats to the Affordable Care Act continue to pile up: Open enrollment was scaled down to 45 days. Funding for groups providing insurance enrollment assistance was downsized. One of two key subsidies were taken away, prompting lawmakers last week to suggest a plan to restore them.

This may be the most difficult time for the federal health law yet. And Florida, with some 1.7 million enrollees, has a lot to lose if the insurance market begins to sputter.

"If you're an insurance company it's all about being actuarially and financially sound. It's about being painfully predictable," said Dr. Leslie Beitsch, a professor at the Florida State University College of Medicine. "We're dealing with an administration that's painfully unpredictable."

Beitsch added: "This might be one of those cases of death by a thousand cuts. Each day, it's a steady parade of things."

State insurance regulators prepared months ago for the loss of the government-funded discount on co-pays and deductibles that close to three-quarters of Floridians receive. Before President Donald Trump signed an executive order to eliminate the subsidies, insurers were warned to submit new, and often higher, rates to account for the potential change.

Although a large majority receive discounts on their premiums, which the government heavily subsidizes, other out-of-pocket costs continue to rise, creating a hardship for some exchange customers.

This year, for example, a family of four purchasing a standard health plan on the exchange in Volusia and Flagler counties and an income of $57,000 or less could pay between $100 and $150 more after the subsidy is applied, according to an analysis by the Florida Office of Insurance Regulation. An individual buying a so-called silver-level plan with an income no greater than $27,000 would pay about $55 less, according to government estimates.

Still, the onslaught of changes this year initiated by Trump has left community groups, academics and consumers uneasy about what's to come when open enrollment begins Nov. 1. One of the underlying questions is: Will Floridians flock to the program again in record numbers?

A poll by the Kaiser Family Foundation showed that well over half of the uninsured population does not know when open enrollment starts or ends this year. (Enrollment begins Nov. 1 and ends Dec. 15.) Those previously insured under the health law were better informed but more than one-third were not familiar with the dates either.

"The executive orders that were signed last week put people in this place where they're concerned," said Joyce Case, a program director for the Health Planning Council of Northeast Florida, which runs the navigator program for seven counties, including Volusia and Flagler.

The organization, which employs eight part-time navigators, saw its funding cut by 30 percent this year. At first, the federal government said the program will be funded based on performance. Case said she'd hired another part-time navigator after they were promised more money. But they lost $50,000 instead and she had to let the new employee go.

"We had been told in the summer that we were going to receive an increase of about $14,000," she said. "It was disheartening to get a decrease (in funding)."

With the shorter enrollment period, Case said the council plans to extend the working hours for navigators, in addition to attending community events and holding enrollment workshops. Her message to consumers has been that it's still business as usual. "Everything is still in place with the ACA," Case said, including the tax penalty. "Nothing has been changed."

The headlines in recent weeks haven't been as confident.

Nationwide, some insurers have found themselves scrambling to react to the abrupt decision not to fund one of two key subsidies. Not in Florida, though.

Florida Health Care Plans in Holly Hill, for example, one of the area's largest providers on the exchange, said it doesn't expect the removal of the cost-sharing reduction subsidy to affect the coverage it offers next year.

One reason is that the government continues to underwrite premium payments. Many insurers in the state responded by asking to charge higher premiums -- the portion the government helps pay for instead of asking consumers to pay higher co-pays and deductibles (covered by the subsidy that's in jeopardy).

"The decision to not continue funding cost share reduction payments will not impact our members in 2017," Bissy Holden, a spokesperson for Florida Health Care Plans, said in an email.

"Despite the federal government's announcement that it will no longer fund cost-sharing reductions, we will make no changes to our existing ACA plans for 2017 as we will absorb the financial impact of that decision."

Consumers like Lisa Reynolds, a DeLand resident who has purchased coverage through the program since 2014, is worried about the rising out-of-pocket costs. A caregiver for her disabled husband, Reynolds has seen her co-pays and premiums rise year after year.

Reynolds blames some of the increase on choosing a big name insurer one year, but the costs rose even after she switched to the HMO Florida Health Care Plans.

"In 2014, I had a plan where I only had a $10 co-pay to go to the doctor. Then the next year it was a $15 co-pay to go to my doctor but the specialist fees were going to go up to $35 instead of $20," she said

In 2017, Reynolds said her co-pay was $25 and she has to pay $40 to see a specialist.

A former high level social services administrator, Reynolds said she and her husband, an Army veteran, lost their business and two homes after he suffered a stroke. The Veterans Affairs Administration covers his medical needs, but for years she is on her own for coverage.

Save for one minor surgery, Reynolds said, she's been healthy. It's critical that she be able to take care of her husband or else he'd be in a nursing home, she said.

"For me, it's just nice to know that I'm going to get a mammogram and a pap smear and a physical just to see if there is anything going on because I have to take care of my husband."

___

(c)2017 The News-Journal, Daytona Beach, Fla.

Visit The News-Journal, Daytona Beach, Fla. at www.news-journalonline.com

Distributed by Tribune Content Agency, LLC.