The Affordable Care Act lives, and with Democrats winning the House of Representatives, it’s safe for at least the next 2 years. Despite a need for some bi-partisan cooperation to improve it (and end the sabotage of it), it’s still meeting its original intent – expanded access to health insurance, pre-existing condition coverage for all, essential health benefits, and subsidized coverage through exchanged and Medicaid expansion, to help pay for those who cannot afford it.
The citizens of 3 Republican-led states (ID, NE, UT) just overruled their state governments by overwhelmingly passing Medicaid expansion (a critical component of the ACA) with statewide ballot proposals in the mid-term elections. That brings the total of states with Medicaid expansion up to 36 (+DC).
As for ACA exchange plan prices, it’s been reported that prices in 2019 will go up by an average of just 2.76%, but would have actually declined by 5.37% without sabotage. Most Americans will still be able to find a 2019 ACA marketplace plan for less than $100 with subsidies factored in.
Open enrollment for the 2019 ACA plans is live at healthcare.gov, as of November 1. I’ve provided resources and answers to a number of common questions about ACA enrollment below.
If you want to help those who don’t have employer-sponsored health insurance plans, please spread the word to as many people as you can (share this article!). This is very important, because…
Listen All Ya’ll It’s a Sabotage!
As part of current ongoing efforts by the current administration to sabotage the ACA by driving down enrollment, they have:
- Cut marketplace enrollment time in half by moving up the final enrollment date to December 15, versus January 31, as it used to be.
- Slashed marketing and outreach funds by 90% to $10 million, down from $100 million.
- Cut grants provided to “navigators” who educate, guide, and enroll consumers in plans by 84%.
- Repealed the individual mandate, driving down incentive for healthy individuals to register, and raising costs for those who do.
- Expanded access to junk “short term” plans, association health plans and health sharing ministries – which will drive healthy people out of marketplace exchange plans and in to risky junk plans, while raising the costs for those remaining.
- Instructed Department of Health and Human Services regional directors to not help states with enrollment as they have in years past (in fact, this is their job).
- Cut Cost Sharing Reduction (CSR) payments, which were used to directly offset deductibles and co-pays for low income Americans. As a result, insurers in many states have already raised premiums or added surcharges (most by more than 20%). Other insurers will exit the market, reducing consumer choices and competition.
And that’s just the short list. All of this sabotage is meant to increase uncertainty in the insurance markets and reduce the number of healthy, younger individuals who sign up for plans through the exchange. Healthy individuals are needed to reduce the risk pool and lower premiums for everyone. Without them, everyone’s prices will go up.
The sad part is – there is absolutely no benefit to doing any of this. Reducing investment in the program actually increases costs. In regards to cutting CSR payments, for example, last year, the Republican-led Congressional Budget Office (CBO) found that:
- Stopping CSR payments would raise federal budget deficits by $6 billion in 2018 and $194 billion over the next ten years, relative to current law, due to increased costs for the ACA’s premium tax credits for low and moderate-income people to offset their rising premiums.
- Marketplace premiums for “silver-level” plans would rise by 20% on average, in 2018. Premiums for such plans would be 25% higher in 2020 and thereafter, relative to current law.
- Marketplace insurers in some states would withdraw from or not enter the marketplaces in 2018. As a result, the share of the nation’s population living in areas with no marketplace insurers would rise to 5% in 2018, up from less than 0.5% under current law.
- The number of uninsured would rise by 1 million in 2018, relative to current law.
Why sabotage then, you may ask? There’s no real reason other than politics and spite, with a total disregard for real people being hurt. People with incomes too high to qualify for the credits will bear the brunt of higher premiums (in addition to taxpayers and future generations with increased deficits).
But DESPITE all this, prices in 2019 will go up by an average of just 2.76% and would have actually declined by 5.37% without the sabotage. Most Americans will still be able to find a 2019 ACA marketplace plan for less than $100 with subsidies factored in. This points to the resiliency and continued potential of the program.
What are the Open Enrollment Dates?
For the 39 states that use the federal healthcare.gov site, plus CT, ID, MD, VT, WA, open enrollment is Nov. 1 – Dec. 15, 2018. Six states (+DC) have their own exchanges with longer open enrollment periods. They are as follows:
|State:||Jan. 1, 2019 Effective Deadline:||Feb. 1, 2019 Effective Deadline:|
|California:||10/15/18 - 12/15/18||12/16/18 - 1/15/19|
|Colorado:||11/1/18 - 12/15/18||12/16/18 - 1/12/19|
|Massachusetts:||11/1/18 - 12/23/18||12/24/18 - 1/23/19|
|Minnesota:||11/1/18 - 12/15/18||12/16/18 - 1/13/19|
|New York:||11/1/18 - 1/31/19||TBD|
|Rhode Island:||11/1/18 - 12/31/18||-|
|Washington DC:||11/1/18 - 12/15/18||12/16/18 - 1/15/19|
Where do I Enroll?
Healthcare.gov (if you’re in one of the 6 states (+DC) with its own marketplace, you will be redirected from there).
If I Currently Have a Plan, Do I Need to Sign Up Again?
If you currently have a plan, it is strongly recommended that you log in to review your options for next year and either renew or switch plans. Significant changes in plans are expected with all of the chaos surrounding the markets (insurers don’t like chaos). Additionally, premium subsidies may change based off of your income and the plans you choose. You will want to update your income and household information appropriately.
Who Should Sign Up for a Marketplace Plan?
Everyone who does not have employer sponsored insurance (either directly or through a family member, including your parents, if you are under age 26), Medicaid, CHIP, or Medicare.
Why Should I Sign Up for a Marketplace Plan?
Because your health and financial solvency is at stake. Even the healthiest among us are just one unforeseen event or imperfect gene away from medical costs that could bankrupt us. Additionally, marketplace plans provide subsidies to roughly 85% of everyone who purchases a plan on the exchanges. If you buy insurance outside of the exchanges, you will not receive subsidies.
With the CSR Payment Cuts, Will I Still Get Subsidies?
Yes – as long as you meet the income requirements. Everyone eligible will still receive premium subsidies. The CSR’s were in addition to the subsidies and helped to cover out of pocket costs on co-pays and deductibles. They will also continue because insurance companies are required to pay them by law. In order to compensate for not getting the payments, insurance companies will increase premiums.
The ACA’s premium tax credits are tied to the premiums for silver plans, so the credits would rise with CSR payments ending (which is why it would cause a federal deficit increase). If your estimated income falls between 100% and 400% of the federal poverty level for your household size, you qualify for a premium tax credit.
What do I Need to Sign up for a Plan?
The Centers for Medicare and Medicaid Services (CMS) has put out a checklist of the information needed for marketplace applications.
Where Can I Get Help Signing up for a Plan, if Needed?
If you have questions about signing up or want to talk through your options with a trained professional, call 1-800-318-2596 or visit https://localhelp.healthcare.gov/#/.
Let’s get everyone enrolled at healthcare.gov!