Illinois consumers to get peek at Obamacare rate changes, but uncertainty remains

July 29--Illinois consumers who buy health insurance on the Obamacare exchange will find out in a few days how much more that coverage might cost them next year -- and if other states are any indication, it's not going to be pretty.

But the Illinois rate proposals, expected to be publicly released Tuesday, still might not be the final word on the matter, even following the Senate's failure early Friday to pass bills to change the Affordable Care Act.

The Trump administration could still weaken Obamacare in ways that would send insurers running from the exchanges or prompt them to try to raise prices further, some experts say. And there's no guarantee that Congress is done trying to overhaul the health care law.

"Insurers still face a great deal of uncertainty," Cynthia Cox, associate director of health reform and private insurance at the Henry J. Kaiser Family Foundation, said in an email.

In Illinois, most people get health insurance through employers or government programs such as Medicare and Medicaid, but this year more than 350,000 Illinois residents enrolled in exchange plans.

On Tuesday, a federally set date for publicly posting rate information, Illinois consumers likely will get a peek at what insurers here have in mind for rate changes.

A number of states have already released proposed rate changes for individual exchange plans, which sometimes have consisted of double-digit increases. Blue Cross and Blue Shield of Illinois' parent company, Health Care Service Corp., has proposed boosting rates for individual plans, on average, next year by 25 percent in New Mexico and about 23 percent in Montana.

Proposed rate changes for Blue Cross and Blue Shield of Illinois coverage for next year, which will be made public Tuesday, were based on a number of factors, including the uncertainty still surrounding parts of the Affordable Care Act, spokeswoman Colleen Miller, said in an email.

The company submitted one set of proposed rates but could still review "and, where appropriate, adjust our rates if we have time," Miller said.

Blue Cross offered exchange plans across Illinois this year and was the only insurer offering them in Lake and McHenry counties. For this year, Blue Cross and Blue Shield of Illinois raised premiums for individual exchange plans in Illinois by 43 to 60 percent.

A Cigna spokesman declined to comment on whether the insurer is returning to the Illinois exchange, and if so, what it plans to charge. Representatives of Celtic Insurance Co. and its parent company, Centene Corp., did not respond to repeated requests for comment, but Centene has announced plans to expand into more state exchanges. Cigna and Celtic offered plans on the exchange this year in Cook County.

add Insurers have some time to decide if they want to propose different rates. Then they have until Sept. 27 to determine whether they truly want to commit to the exchange for next year.

It's still possible some insurers might want to raise proposed rates or pull out of the exchanges, depending on what happens in Washington in coming weeks and months, some experts say. That's because there are certain actions the Trump administration could take, without congressional action, to dampen the law.

Shortly after the Senate failed to pass a reform bill early Friday morning, President Donald Trump tweeted: "As I said from the beginning, let ObamaCare implode, then deal. Watch!"

Insurers still have many unanswered questions, Cox said.

"If insurers don't get answers to these questions from Congress or the White House soon, there is a good chance we will see premiums growing faster or insurers leaving the market," she said.

For one, insurers don't know if the government will stop sending them payments meant to help offset the expenses of reducing deductible and copayment costs for lower-income members. America's Health Insurance Plans, an insurance industry group, said in a letter to senators Thursday that premiums paid by consumers will rise by about 20 percent if the government doesn't continue to make those cost-sharing reduction payments to insurers.

Insurers also wonder how fully the Trump administration will enforce the requirement that everyone buy insurance or pay a penalty. Republican Senate leaders had tried to erase that requirement as part of the so-called "skinny bill" they attempted, but failed to pass Friday morning. But even with that requirement still legally in place, the Trump administration has leeway in how strictly to enforce it.

Insurers worry that without the threat of that penalty, healthy people will forgo buying insurance, leaving insurers with mostly sick, costly customers, which insurers say would drive up costs for everyone.

But Avik Roy, who served as a health care adviser to former presidential candidate Mitt Romney and founded the Foundation for Research on Equal Opportunity, said he doesn't think the penalties for not buying insurance have made much of a difference when it comes to rates.

"Premiums have doubled under Obamacare," Roy said. "Premiums have continued to rise and will continue to rise if nothing changes."

Others, however, say if rates rise significantly again this year, it's likely because of all the tumult and uncertainty that's surrounded Obamacare in recent months.

"If Congress and the president hadn't spent the last seven months trying to undermine" the health care law, proposed increases this year probably wouldn't be too steep, said Stephani Becker, a senior policy specialist at the Sargent Shriver National Center on Poverty Law. Some companies that have left state exchanges in recent months have cited uncertainty about the health care law's future as a reason for exiting, along with financial losses.

A recent Kaiser Family Foundation report, however, showed that generally the individual insurance market has been stabilizing and many insurers have been returning to profitability in their exchange businesses. The Congressional Budget Office also recently said that under current law, the market is anticipated to be "stable in most areas."

Many insurers that are still in the game likely already have baked any remaining uncertainty into their proposed rates for next year, said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation.

"I think a lot of carriers have planned to stay in the market even with understanding there might not be (cost sharing reduction payments) and the mandate (to buy insurance is) not going to be enforced the way it was last year, but I think all of them would say, 'Nothing's final yet, we're still considering our options,'" Hempstead said.

lschencker@chicagotribune.com

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