Obamacare hasn’t driven up insurance costs for most Virginians, studies and experts say
Opponents of what is also known as "Obamacare" have argued it's a doomed system and a disaster for the country. Warnings abound that it has caused health care costs to skyrocket beyond people's ability to pay.
Supporters said parts of the landmark law needed to be fixed but not discarded.
Should most Virginians worry that their health insurance is in jeopardy?
Not according to multiple studies and experts.
They say health insurance for the vast majority of Virginians has remained intact and functioning seven years after passage of the
And the insurance companies that service most residents aren't leaving the state anytime soon.
What is a problem are the costs and availability of health care or insurance for a relatively small but significant number of the state's more than 8 million residents.
Altogether, about 90 percent of Virginians had some form of health insurance last year, according to the
About six of every 10 received insurance coverage through their jobs, including the military. Another 25 percent used government-run Medicare -- for people 65 and older -- or Medicaid -- for poorer residents. About 5 percent bought individual or family coverage on their own.
Kaiser estimated about 813,000 people did not have insurance, a drop from before Obamacare when more than 1 million lacked coverage.
Several hundred thousand of the state's poorest residents are uninsured because they cannot qualify for Medicaid;
The ACA, passed by
They include specific lists of basic benefits that must be included in every policy, along with consumer protections that prohibit insurers from limiting or dropping someone's coverage because their medical problems are expensive. Nor can someone be denied new insurance because of a preexisting condition.
Among the more popular changes is allowing young adults just starting their careers to stay on their parents' policies until they're 26.
It also had attempted to address the chronic problem of tens of millions of Americans -- including more than a million Virginians -- who didn't have sufficient health insurance because they couldn't afford it, didn't have access to it, or just didn't want it. Among those changes are the establishment of insurance marketplaces intended to give individuals or families a place to shop for reasonably priced insurance.
Here's what happened for key parts of the state's population:
Employer-based insurance
It's not news to
Eligible employees in
The average
There are exceptions. Some smaller employers with a smaller pool of workers to share the risk can have higher premiums. Only companies with more than 50 full-time workers are required to offer health benefits or pay a tax penalty.
Employees also have been paying larger and larger deductibles -- the dollars that workers have to spend before their insurance kicks in -- for more than a decade, the federal surveys show. However, as with the premiums, the average annual increases have been smaller since 2010.
For example, the average deductible in
Rae noted that many company plans already were offering insurance choices that included basic coverage now required of all policies.
"The overall driver of cost is absolutely not the Affordable Care Act," Rae said. "The history of insurance is that prices go up and people consume more."
Marketplaces
Perhaps the most troubled element of the ACA is the insurance marketplaces in
The only marketplace exchange provider in
Optima's 2018 price hike raises the average monthly premium to
But the eye-popping increase isn't felt by most individual marketplace customers because they qualify for federal tax breaks or cost reductions that cover the increases, said
Close to 379,000 Virginians bought insurance in the marketplace last year, and 84 percent were able to substantially lower their payments with a tax credit that limited what they owed to a portion of their paycheck, according to the federal
The federal support absorbs the increases because customers getting federal assistance pay only a set portion of their income for insurance, Hanken said.
But about 60,000 other Virginians using the exchange didn't qualify for the credit or cost reductions, the centers reported.
Those higher costs weren't the intention of the ACA.
With Obamacare's requirement that almost everyone have health insurance, the exchanges, begun in 2014, were supposed to be a competitive marketplace where someone could shop for a reasonably priced plan if they couldn't get it through their job, made too much money to qualify for Medicaid or were too young for Medicare.
But there is little competition, due in part to uncertainty in
Next year, most
"The problem with the exchanges right now is too many sick people and not enough well," Gray said, because those who qualify for the subsidy don't feel the increase in costs. "The people who drop out are those who get no subsidy because their premiums are outrageously high."
Medicaid
About half of the 1.3 million Virginians who use Medicaid are children in low-income families. Another one in four are their parents, caregivers or pregnant women. The rest are people with disabilities or elderly residents who rely on the program to supplement costs not covered by Medicare, including long-term care.
Kaiser noted two-thirds of Medicaid funds in
Gov.
The Republican-controlled legislature has repeatedly rejected the expansion, with many arguing they cannot be assured that
McAuliffe said last week he's also concerned that federal funding for
Uninsured
The ACA has made a dent in the number of Virginians with no health insurance.
More than one million Virginians had none when the law was passed, but that population dropped to about 814,000 in 2016, Kaiser estimated. But estimates can vary -- the census, for example, says it was closer to 700,000 last year.
Gray contends the day will never come when everyone has health coverage.
"There's probably about 4 percent of the population that you're never going to get insured," Gray said. They can include that itinerant or homeless or young and old who for their own reasons don't want insurance, he said.
The bulk of uninsured Virginians cannot afford the costs despite having full-time jobs, according to an analysis of 2015 data conducted recently by the
About 77 percent are members of families where one or two people have full-time jobs. Another one in five were in families where someone works part time.
They represented a cross section of the state. Close to half were white, one in four were black, one of every five Hispanic and six percent Asian. Seventy-seven percent were American citizens, according to the study.
"We have a very vibrant health care safety net here in
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