OPINION: How Obamacare’s saboteurs are raising your health care cost | Opinion
But
At least 900,000 more Michiganders have health coverage today than before the ACA kicked into high gear three years ago. Most joined the ranks of the insured when
The collapse of the Republican campaign to dial back federal funding for Medicaid means that
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Fact check: Trump distorts facts on insurance cost-sharing subsidies
Who's at risk now?
When Trump and other critics talk about the imminent implosion of Obamacare, they're really talking about the fragility of the state exchanges where small businesses and individuals who enjoy neither Medicaid eligibility nor employer-provided health insurance must go to purchase coverage that meets the requirements established by the ACA.
Part of the problem is that the so-called individual mandate doesn't really require young people (or anyone else) to buy health insurance; it simply threatens to exact a tax penalty every
Under current federal rules, moreover, even those who decide to buy policies can drop coverage -- or simply stop paying their insurance premiums -- with the confidence that they'll be able to renew coverage with no penalty if they need medical services down the road. The more expensive it is to buy insurance on the state exchange, the greater the incentive to forgo coverage until an injury or serious illness arises.
If federal policymakers were determined to making the state insurance exchanges work the way they were designed to, they would 1) encourage healthy people to purchase coverage, and 2) vigorously enforce tax penalties against those who declined.
(
Since
It would be an overstatement to suggest that the Trump administration is exclusively responsible for declining enrollments, or for the decision some insurance companies have made to get out of state insurance exchanges that have ended up serving a pool of policyholders that has turned out to be smaller, older and more expensive than they hoped.
But the administration's malign neglect has certainly discouraged some healthy adults who might otherwise have signed up for coverage from doing so.
Terrorizing insurers
The most imminent threat to the health of the individual insurance market, of course, is Trump's threat to stop reimbursing insurers for the discounted co-pays they give to lower-income policyholders. The president's cynical premise is obvious: If Republican lawmakers can't figure out how to repeal Obamacare, maybe his administration can starve it to death.
More than four-fifths of Michiganders who purchase health insurance on the state exchange reap a tax credit for doing so. The cost-sharing reduction payments Trump keeps threatening to withhold, known in the insurance industry as CSRs, are designed to reduce the cost of coverage for lower-income policyholders further by subsidizing the deductibles they have to pay for prescriptions and medical services.
Policyholders who qualify for such discounts will continue to enjoy them through the end of 2017, no matter what the Trump administration does, because the discounts are baked into the coverage plans they signed up for.
What's at risk is the checks the federal government sends insurers each month to reimburse them for the discounted co-pays some policyholders pay.
The CSRs were part of the ACA's grand design, and the Obama administration continued to make them even after Republican legislators declined to fund them. But a lawsuit has raised doubts about the legality of that work-around, and the new administration has repeatedly threatened to withhold the payments, although it has continued to make them.
Last year, the nine companies that offer individual coverage on
A plan for all seasons
Under deadlines established by the state and federal governments, insurers were required to submit the insurance plans they propose to offer on
Last week, the state
Still,
"It is absolutely absurd that three months before open enrollment, we don't know what our plan designs are and how they're going to be paid for," complains HAP CEO
Quiet before the storm
So far,
But that stability could vanish quickly. BCBS is the only company that offers individual coverage in all of
Even if the CSRs are assured, BCBS policyholders renewing coverage for 2018 face average premium increases of 14%-26%. HAP's individual policyholders can anticipate an average hike of 16% (although Kline says the increase would have been smaller if her company had been able to factor in improvements in the overall health of its insurance pool before premium schedules were due June 1).
Finally, although insurers can no longer adjust the rates or coverage plans they've proposed for 2018, they have until late August to pull any of those plans from the market. BCBS says it expects to stick with what it's proposed, but HAP will likely withdraw some of its offerings depending on how the CSR issue is resolved.
Ray of sunshine
The good news is that
And because declining unemployment is making the competition for workers more keen, few insurers expect small-group enrollment to decline -- even if congressional reformers succeed in relaxing the insurance mandate for small businesses, an idea that enjoys support in both parties.
Whether individuals in
Right now, the most concrete plan to do that is the one being offered by a bipartisan group I wrote about last week. Divided equally between
If your representatives in
Contact
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