Change and confusion as Obamacare open enrollment begins

The Republican-dominated Congress has debated its end repeatedly. President Donald Trump has eliminated subsidies to participating insurers. And 90 percent of its outreach and advertising budget was killed.

Still, the Obamacare show must go on.

Wednesday marks the first day of open enrollment on the individual health insurance marketplace created by the Affordable Care Act, aka Obamacare. The so-called exchanges allow people whose income levels exceed Medicaid limits or who don’t receive insurance through their employer to buy health coverage, often at a subsidized rate.

For the first time since its 2013 launch, the enrollment period when newcomers can sign up for coverage and returning customers can change their plans will be 45 days instead of 90.

That has state regulators working at a frenzied pace to restructure marketing tactics and ensure that all sign-up counselors, called navigators, are fully briefed on the change.

Nevada’s Democratic leaders and health-care advocates have held news conferences, sent news releases and attended outreach events to inform the general public that Obamacare is still law of the land.

They’re also doing what they can to spread the word that the sign-up period this year will expire on Dec. 15. Nevada’s marketplace, the Silver State Health Insurance Exchange, is using its $3.2 million outreach and marketing budget to make up for a lack of federal involvement.

Confusion reigns

“I think what’s happening is we’re seeing the rhetoric create a confusion that consumers are concerned whether or not plans will exist, or subsidies will exist,” said Heather Korbulic, executive director for the exchange. “We’re really concerned about making sure that we have younger and healthier people in the mix,” people whose low insurance use offsets costs from high-use patients.

National polls show the majority of uninsured and those currently on marketplace plans don’t know when the enrollment period begins or ends. They didn’t see ads ahead of the open enrollment start date, a report from the Kaiser Family Foundation said.

Factoring in the reduction in federal outreach, a cut to cost-sharing reductions, as the payments to insurers are known, and a shorter enrollment period, S&P Global Ratings predicted Tuesday that enrollment could fall 7 percent to 13 percent for 2018.

At the state Department of Health and Human Services’ Office of Consumer Health Assistance, enrollment efforts are becoming increasingly hands-on.

Navigators are reaching out one-on-one to people who came through their office in the last year, but were ineligible for coverage at the time, said Janise Wiggins, the governor’s consumer health advocate.

Subsidies cut, but premiums fall

When the White House announced in mid-October it would cease to provide the cost-sharing reductions, it didn’t exactly come as a surprise to insurance companies, many of which — Nevada’s included — had already adjusted premiums to offset the cuts.

Instead, insurers will be reimbursed for the portion of the premium a customer can’t pay through advance premium tax credits, another subsidy available under the ACA. The use of this alternative will actually lower premiums in many U.S. counties for those whose incomes fall below 400 percent of poverty level, the Kaiser Family Foundation recently calculated.

That’s because insurers in Nevada hiked premiums on silver plans, the benchmark for determining advance premium tax subsidies, to account for the cut in the cost-sharing payments. That increased the tax subsidies, bringing down the cost for low-income consumers and insurers.

For example, a low-cost midtier silver plan for a 40-year-old Clark County resident who makes $25,000, or 207 percent of the federal poverty level, would come at a monthly cost of $118 in 2018 compared to $139 in 2017. The least expensive gold plan for the same person would cost $169 in 2018, 20 percent less than the $210 premium this year.

Above the 400 percent poverty level, the financial relief vanishes. If that same 40-year-old makes more than $47,080 annually, premiums will rise.

According to Healthcare.gov, the federal health insurance exchange, the estimated annual cost of the lowest-cost silver plan for a 40-year-old who makes $48,000 would hover around $6,355 — about 13 percent of their annual income.

In other words, Korbulic said, despite Republican-backed changes to a Democrat-backed law, middle-income folks are still left behind.

“For consumers who don’t get subsidy assistance, the increasing rates are becoming unattainable,” Korbulic said. “At some point, when you’re looking at increases of 36 (percent) to 38 percent you get priced out of the marketplace.”

And if the administration continues to undermine Obamacare, the marketplaces could indeed “implode,” as President Donald Trump has suggested, she said.

“With this current level of instability and uncertainty, it’s not a sustainable endeavor,” Korbulic said.

Reaching the young and healthy

One thing that would help, Korbulic said, would be young and healthy people — those who use their insurance infrequently — showing up and enrolling.

“It’s important it isn’t just a risk pool of people getting sick, because that means prices will go up for everyone,” she said.

The exchange is using advertising targeted at young families, running ads that show a person falling off their bike or a child taking a soccer ball to the face, to encourage them to participate.

The exchange will kick off open enrollment Wednesday at a noon to 7 p.m. event at St. Rose Dominican Hospital’s San Martin Campus, 8280 W. Warm Springs Road. There enrollees can meet with licensed navigators for free sign-up assistance.

Contact Jessie Bekker at jbekker@reviewjournal.com or 702-380-4563. Follow @jessiebekks on Twitter.

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Siegel Cares, the charitable wing of The Siegel Group, delivered toys to families at their apartment complexes in Las Vegas. (K.M. Cannon/Las Vegas Review-Journal)
Revisiting “Christ the King” sculpture
A longtime admirer of the sculpture at Christ the King Catholic Community in Las Vegas shares her perspective. (Bizuayehu Tesfaye/Las Vegas Review-Journal @bizutesfaye)
Henderson couple adds another school to their generosity
Bob and Sandy Ellis of Henderson, who donate to several Clark County School District schools, have added Matt Kelly Elementary in Las Vegas to their list of schools where every student gets new shoes, socks and a toy. (K.M. Cannon/Las Vegas Review-Journal)
Terry Fator Christmas House
Arguably better than a hotel holiday display, is Terry and Angie Fator's home located in southwest Las Vegas.
UNLV Winter Graduation Packs Thomas & Mack
UNLV's 55th winter commencement ceremony included approximately 2,146 undergraduate and graduate students who recently completed their studies. (Benjamin Hager/Las Vegas Review-Journal)
Build-A-Bear comes to Reed Elementary School
Students participated in a Build-A-Bear-Workshop at Doris Reed Elementary School in Las Vegas, Thursday, Dec. 13, 2018.
Rev. Father Seraphim Ramos talks about Greek Orthodox icons during an interview with the LVRJ
Rev. Father Seraphim Ramos talks about Greek Orthodox icons during an interview with the Las Vegas Review-Journal at St. John the Baptist Greek Orthodox Church. Bizuayehu Tesfaye/Las Vegas Review-Journal @bizutesfaye
Masjid Ibrahim Islamic Center art depicts names of God
Masjid Ibrahim Islamic Center founder Sharaf Haseebullah talks about new diamond-shaped art panels featuring some of the 99 names of Allah at the main entrance the Las Vegas mosque. (K.M. Cannon/Las Vegas Review-Journal)
Holiday poultry with Tim and Chemaine Jensen of Village Meat & Wine
Tim and Chemaine Jensen of Village Meat & Wine explain the different types of poultry available for the holidays. (Heidi Knapp Rinella/Las Vegas Review-Journal)
Catholic Charities hosts early Christmas meal
Students from the Bishop Gorman High School football and cheerleader team helped to serve food at the Christmas meal sponsored by the Frank and Victoria Fertitta Foundation at Catholic Charities of Southern Nevada on Sunday. (Rachel Aston/Las Vegas Review-Journal)
Incarcerated Christmas
This is the fourth year HOPE for Prisoners has worked with the Nevada Department of Corrections to create a Christmas for prisoners to visit their families. (Rachel Aston/Las Vegas Review-Journal)
2018 Homeless Vigil
Straight From The Streets holds its 23rd annual vigil to remember the 179 homeless individuals who died in Clark County this year.
Getting through the Holiday blues
Psychologist Whitney Owens offers advice on keeping your mental health in check during the Holiday season in Henderson, Thursday, Dec. 13, 2018. (Caroline Brehman/Las Vegas Review-Journal)
Operation Homefront Holiday Meals for Military
Operation Homefront Holiday Meals for Military program gave meal kits to 200 families at Veterans of Foreign Wars Post 10047 in Las Vegas Wednesday, Dec. 12, 2018. It all started with a chance encounter in a supermarket in Utica, N.Y., near Fort Drum. A soldier, his wife and infant had a handful of grocery items they couldn't afford. A Beam Suntory employee picked up the $12 cost for the groceries. The program has grown from providing 500 meal kits to military families in 2009 to providing more than 7,000 nationally this holiday season.K.M. Cannon Las Vegas Review-Journal @KMCannonPhoto
An elegant Tea Party for substance abuse and homeless women
An elegant Tea Party for substance abuse and homeless women at WestCare Women Children Campus in Las Vegas. Bizuayehu Tesfaye/Las Vegas Review-Journal @bizutesfaye
Former 51s manager Wally Backman chats about new job
Former Las Vegas 51s manager Wally Backman talks about his new job with the independent league Long Island Ducks during the Baseball Winter Meetings in Las Vegas, Nevada, on Dec. 10, 2018. (Ron Kantowski/Las Vegas Review-Journal)
Inside the kitchen at Springs Preserve
The staff of Divine Events do party preparation in the kitchen at Divine Cafe at Springs Preserve. With nine parties the following day, this is a particularly busy time for the crew. (Heidi Knapp Rinella/Las Vegas Review-Journal)
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