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.
“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.
Things you need to enroll
— A valid Nevada driver’s license
— Permanent resident or alien registration card, if applicable
— Social Security cards and birth dates for all household members
— Proof of residency
— Estimated 2017 household income
— A copy of any current insurance information
To enroll online, visit https://www.healthcare.gov/.