Future of health care unclear as fate of Obamacare hangs in the balance

Dec. 31--The Affordable Care Act -- President Barack Obama's landmark health reform bill -- took some hits in 2016, but it could be in for a real beatdown this year.

The decision last year by some of the nation's most powerful insurance companies to pull out of the health exchanges left consumers with fewer choices. Premiums and deductibles are up for 2017 coverage, both on and off the exchanges. And taxpayers are facing a bigger bill to help cover people eligible for subsidies.

The insurer exits, premium hikes and dwindling choices prompted critics to declare doom for the law known as Obamacare by opponents and some supporters. But the Obama administration has rejected any doomsday talk and has vigorously defended the benefits of the bill that has brought uninsured rates to historic lows.

It's unclear what will become of the Affordable Care Act under a Donald Trump presidency. Trump has vowed to replace the law with something else, but has backpedaled on his comments by admitting he favors some of the law's more popular elements, including language on pre-existing conditions and allowing children to remain on parents' policies until age 26.

"It was a difficult year because of the departures by insurers," said Paul Ginsburg, director of public policy at University of Southern California's Schaeffer Center for Health Policy and Economics. "The ironic thing is that the exchange seems to be stabilizing."

The majority of Americans have employer-based coverage and premium growth there remained relatively low in 2016, according to the Kaiser Family Foundation. But while premiums may have remained stable, workers are still paying more as deductibles continue to climb.

"The real challenge here is health care in the U.S. is incredibly expensive and beyond the reach of the average family," said Larry Levitt, a Kaiser executive.

Exits from HealthCare.gov

UnitedHealth Group Inc., the nation's largest insurer, said it would no longer offer individual health insurance in Missouri starting in 2017. The company said it would only participate in a handful of states in order to stem its financial losses due to enrolling older and sicker individuals than expected.

Months later, Aetna said it too would back away from its exchange business, including in Missouri. Aetna does business as Coventry here.

For Missouri consumers it means less competition and choice, factors tied to higher prices. For Missourians, Aetna and UnitedHealth leaving means 96 of Missouri's 114 counties will only have one insurance carrier in 2017.

For 2017 coverage, consumers in the St. Louis area have a choice of Anthem Blue Cross Blue Shield or Cigna. And the two have drastically different networks. Generally, Cigna only covers BJC HealthCare, while Anthem covers SSM Health.

And to complicate matters further, Anthem is in the process of acquiring Cigna, a threat to competition in the area in the future. The Justice Department is currently fighting the merger in court along with the other mega-merger between health insurance giants Aetna and Humana.

Critics have said the exits, fewer choices and increased prices mean HealthCare.gov and the law isn't working. The Obama administration has said vigorously denied that characterization.

As of late December, 6.4 million Americans picked a health insurance plan for 2017, ahead of last year's pace, the U.S. Department of Health and Human Services said. That's a clear sign "doomsday predictions" were not accurate, HHS Secretary Sylvia Burwell said in a December conference call.

Missouri enrollment increased by 3 percent, compared with the same period last year, officials said.

But while many of the nation's largest insurers have knocked the exchanges and the ability to make money, Clayton-based Centene has found success. The Medicaid managed-care contractor considers the exchange business a lucrative niche to its core business.

"There are a number of signs that the marketplaces, while fragile up until now, are stabilizing -- enrollment is up so far for 2017 and there are reports that more insurers are starting to make money," Levitt said. "If left alone, insurers would very likely be profitable next year in their marketplaces and the individual insurance market, overall, would be sustainable over the long term."

employer-based coverage

While premium increases held relatively steady in 2016, deductibles continued to grow, according to Kaiser.

Average annual premium increases for individual coverage was $6,435 -- for both the worker and employer's contribution. For a family, that figure is closer to $18,000. And that's just for premiums.

The average annual deductible for an individual increased to $1,478 in 2016, up from $1,318 the year before, according to Kaiser.

"Now that there has been a movement toward higher deductibles to suppress the growth of premiums I start wondering about how many people's finances are being wrecked by having an illness that's not even that bad but costs them a few thousands dollars a year," Ginsburg said.

Samantha Liss --314-340-8017

@samanthann on Twitter

[email protected]

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