NJ Obamacare enrollment begins Nov. 1; why are premiums rising again?

Oct. 31--TRENTON -- But consumers will continue to enroll for plans through the federal government's web site, HealthCare.gov, at least for another year.

While the debate continues to rage over the best way to provide health coverage, "my personal opinion is we're halfway up the ACA mountain," Gov. Phil Murphy said. "Let's make the most of what we've got."

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Murphy spoke Wednesday at a kickoff for the open enrollment season for the Affordable Care Act, popularly known as Obamacare, during which consumers who aren't covered by their employer or Medicare can find health insurance for 2020. It affects about 300,000 New Jerseyans.

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The program launches while the seemingly endless tug-of-war over Obamacare continues.

The Trump administration and 18 states have argued the law is unconstitutional and have asked a federal appeals court to throw the law out. Meanwhile, some Democratic presidential candidates are calling for an overhaul through a Medicare for all program.

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That battle, however, won't affect New Jerseyans' health insurance for next year.

What you need to know:

What are the basics?

Sign-up begins Friday and runs through Dec. 15. In New Jersey, at least, consumers are required to have health insurance or pay a penalty of 2.5% of their household income, or $695 per adult and $347.50 per child, whichever is higher.

Consumers signing up through the exchange are eligible for subsidies to lower the monthly premiums if they make less than four times the federal poverty level -- $47,000 for an individual and $97,000 for a family of four.

What are my choices?

New Jersey unveiled GetCovered.NJ.gov, where consumers can shop for policies. They can choose among three health insurers on the exchange: AmeriHealth New Jersey, Horizon Blue Cross Blue Shield and Oscar.

Premiums for 2020 have increased on average 8.7%. The breakdown: AmeriHealth is up 11%; Horizon is up 6.5%; and Oscar is up 16.8%.

Didn't premiums fall last year? What happened?

Yes, they declined 9% last year thanks in part to a New Jersey reinsurance program to help carriers pay for high-risk patients.

Now it appears the state is back to grappling with rising health care prices. By one measure, employer-sponsored insurance spending rose 16.8% in New Jersey from 2013 to 2017, according to the Health Care Cost Institute.

That was due more to an increase in prices than excessive use of services, said Linda Schwimmer, president and chief executive officer of the New Jersey Health Care Quality Institute, an advocacy group.

Meanwhile, health insurers can charge an administrative fee of up to 20% in the individual market, "so as the prices go up on the medical costs, the administrative fees go up as well," she said. "All leading to overall higher premium prices."

It's too complicated. Where can I get help?

The Murphy administration awarded a total of $1.1 million to five navigators, organizations that help consumers sign up for health insurance.

They are: Fulfill in Monmouth and Ocean counties; Center for Family Services, based in Camden; Family Resource Network in East Windsor; The Orange's ACA Navigator Project; and the Urban League of Hudson County.

Michael L. Diamond is a business reporter who has been writing about the New Jersey economy for 20 years. He can be reached at 732-643-4038; [email protected]; or on Twitter @mdiamondapp.

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