Affordable Health Care Under Trump
Some health insurance plans selling on the Obamacare marketplaces are planning steep 2018 rate increases, in part to account for the uncertainty over how the Trump administration will administer the law. The administration has been aggressively ambiguous about key policy issues, like whether it will enforce the health care law’s individual mandate or pay out insurance subsidies aimed at the lowest-income Obamacare enrollees. In response, insurance executives are say8ing they will charge steeper rates in 2018 in order to avoid losing money. Others are quitting the marketplace altogether, saying the future just looks to uncertain to take a gamble.
“We were hoping for more stability this year,”comments coming from a chief executive at Blue Cross Blue Shield insurance. “But those above factors have lead to instability, and the beginning of a death spiral” for The Affordable Health Care Insurance Market.
The ACA marketplaces were already struggling to attract health insurance plans last year, while President Obama was still in office. Major insurance plans like UnitedHealth and Aetna quit selling coverage there because the population that signed up was sicker than expected.
The uncertainty that the Trump administration has created over how they will run health law programs, industry sources say, has made those problems worse — just when some thought the marketplaces were beginning to stabilize.
“The health plans I work with want to stay in, but the Trump administration is not making that easy,” says insurance industry consultant Robert Laszewski.
Insurers plan to charge higher premiums to account for uncertainty around Trump policy
Multiple health insurance plans have said that their premiums will be higher in 2018 specifically because of Trump administration actions. This includes CareFirst, a BlueCross BlueShield plan in Maryland, Virginia, and Washington, DC. The insurer submitted its 2018 premiums last week, averaging a 52 percent increase in Maryland and 39 percent in Virginia. Plans would have had hikes this year anyway, because they have lost money during its three years on the ACA marketplaces. So tacking on an extra 15 percent to its premiums because of unexpected forces from the Trump administration to enforce the individual mandate.
“The current approach at the federal level has been to say they’re not going to enforce it,” We think the effect of that is to encourage healthy people not to enroll.” Comments from Evergreen Health, a small insurance plan in Maryland.
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The biggest uncertainty, however, insurers see on the horizon is whether the Trump administration will pay cost sharing reduction subsidies. This is an $8 billion pool of funding to reduce co-pays and deductibles for low-income Obamacare enrollees. The House filed a lawsuit in 2010 arguing that these subsidies were illegal. The Trump administration has said it will continue making those payments so long as the lawsuit is active. It has not, however, clarified whether it intends to continue defending those subsidies in court — and that is making health insurance plans nervous.
Insurers had hoped that Congress would appropriate funds for this spending in the budget bill it passed last week. The bipartisan bill did not include that money, leaving the health plans in limbo.
“It’s pretty clear we need more certainty to be able to file the rates assuming we get those federal payments,” says Paul Markovich, chief executive of Blue Shield of California. “Short of that, we’d have to assume they’re not being paid.” Markovich says that his plan is currently preparing different rates to respond to different scenarios that could play out. The hard part will be choosing which one to submit, if the Trump administration does not provide further clarity.
“The most logical thing to do would be to pass an appropriation, especially when this lawsuit is outstanding,” he says. “Saying that we plan to continue the payments when the legality of the payments could be ruled against doesn’t provide certainty.” New Mexico Health Connections, a non-profit co-op plan, isn’t taking any chances. Their Chief executive Martin Hickey says the co-op currently plans to file higher premiums that assume the Trump administration won’t make those subsidy payments. This Uncertainty breeds higher costs,” he says. “We have to plan for the worst case scenario until it finally gets decided. We have a lot of things to focus on, we’re grinding out hours over rates, and it doesn’t help that people are running around with zombie bills.”
Where does this unending saga of President Trump’s administration governing instability become sensible??? What can we expect from a man who business legacy consist of numerous bankruptcies that have followed him since he started a paper route business in his early teens.