Iowans signing up for Affordable Care Act down slightly

Dec. 26--Enrollment for health plans through the Affordable Care Act dipped slightly in Iowa this year, and while many factors played into that drop, state insurance officials say the problems that have been plaguing the individual market will continue to force people out

While Iowa Insurance Commissioner Doug Ommen pointed to challenges within the federal individual market, he added that the effect from new, so-called skinny health coverage plans in the state is minimal.

"We don't see the Farm Bureau plan as having much impact at all on those that are otherwise served by the ACA plans," Ommen said by phone on Wednesday. "They are an answer for those families who are above the 400 percent federal poverty level."

Nationwide, enrollment this year through the federal exchange dropped from the previous enrollment period, according to data from the Centers for Medicare and Medicaid Services released this month. However, the agency emphasized the data was preliminary and did not represent final fiscal numbers for 2019 coverage year.

Sign-ups fell to 8.5 million this year, a drop from the approximately 8.8 people who signed up for coverage at the same time last year.

Of the 8.5 million Americans who signed up for 2019 health coverage, 6 million were renewing their coverage and 2 million were new consumers to the healthcare.gov platform.

The number of individuals renewing coverage remained steady from 2018, but new consumers on marketplace was slightly higher in 2017, according to CMS.

Forty-nine thousand Iowans signed up for coverage during this year's open enrollment period, from Nov. 1 to Dec. 15 -- for health insurance for 2019.

At this time last year, 53,000 individuals living in Iowa enrolled for their health insurance through the ACA.

However, Ommen said that figure is an inaccurate representation of final 2018 enrollment. The actual number likely was closer to 37,000, he said.

Many individuals who had coverage through Aetna -- the insurance company that exited the individual market for 2018 -- automatically were enrolled into Medica, and dropped the plan by the end of the year.

The 49,000 enrollees are more representative of the population below 400 percent of the federal poverty level, the income bracket where individuals are eligible for tax subsidies, Ommen said.

"I know it's being reported as a drop, but I view it as a very stable number," Ommen said. "That may not be consistent with nationally because national numbers are down as well.

"That's my view of what has happened here in Iowa, that it's closer to what I would have expected given the dramatic increase in rates last year."

A shift in enrollment is expected, given the changes in the individual market this past year, Ommen said.

Aetna was not the only insurance company to drop out of the marketplace for 2018. Its departure was preceded by Wellmark Blue Cross and Blue Shield, leaving only one insurer for Iowans seeking ACA coverage.

Officials from both insurers blamed high costs and the uncertain political future of the Obama-era law.

Wellmark since has rejoined Iowa's individual market, with plans available to Iowans for 2019.

The appearance of new skinny health plans for Iowans this coming year, however, did not impact the withdrawal of unsubsidized Iowans from the individual marketplace, Ommen said.

The Iowa Farm Bureau unveiled its new health plans earlier this year as an option for individuals who don't qualify for subsidized coverage in the marketplace.

Officials with the agency have not released enrollment totals for the Farm Bureau Health Plan, which has been accepting applications since November. Anyone can purchase plans throughout the year, and are not limited to a specific enrollment period.

"We have had a steady influx of applications," said Laurie Johns, spokeswoman for the Iowa Farm Bureau, in an emailed statement to The Gazette. "We continue to tally the numbers and receive applications, but it is clear that the Farm Bureau Health Plan is a good option for some, not a replacement for the ACA coverage.

" ... A significant majority of ACA enrollees receive tax credits which greatly reduces their premium cost and makes those ACA plans a more cost-effective option."

The Farm Bureau plans are not subject to state oversight or federal regulation.

But factors within the federal individual market itself are causing Iowans ineligible for subsidies to withdraw from the individual market -- factors that Ommen hopes Congress will address in the coming year.

Tax-based subsidies that are unpredictable, age band rating within the ACA population and a lack of flexibility in benefits for younger, healthier enrollees are just a couple of the issues Ommen hopes federal lawmakers can change.

The commissioner said the best option to create competition for skinny plans such as the Farm Bureau's health plan would be to address concerns within the federal marketplace.

"If Congress doesn't give us the authority to restore the risk pool in the ACA, it's not going to operate," he said. "Right now, it's only operating for people that get 80 percent of their premiums paid by other taxpayers."

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