Obamacare still vital
Signature health care law remains intact despite GOP assaults
Jeremy M. Lazarus | 10/19/2017, 5:35 p.m.
By Jeremy M. Lazarus
Don’t panic if you bought individual or family health insurance coverage through the Affordable Care Act marketplaces.
The ACA, a.k.a. Obamacare, is struggling but still alive and will continue to operate, according to experts in the field, despite President Trump’s decision last week to cut off premium subsidies to insurance companies.
It is still uncertain whether the Trump decision will stick. Attorneys general from Virginia to New York are threatening lawsuits aimed at reinstating those payments.
And despite the decision, the ACA marketplaces will still open Nov. 1 for enrollment.
More importantly, “everyone who qualified for reduced premiums and/or tax credits” to help pay the cost of health insurance will still qualify for those benefits if their income did not increase much, said Jill Hankin, an attorney and director of the Center for Healthy Communities at the Virginia Poverty Law Center in Richmond.
That’s good news for people like Shirley L. Evans, 33, a receptionist at a dental office in Richmond and the single mother of two young children.
As a working adult making $22,500 a year, she makes too much to qualify for Medicaid, which provides only for persons below the 2017 poverty line, $12,600 for an individual, $16,240 a household of two, $20,420 for a family of three and $24,620 for a family of four.
Because her employer does not offer group health coverage for the staff, she relies on the ACA for her coverage. She currently pays less than $130 a month for insurance for herself; her children are covered through the Children’s Health Insurance Program.
“Look, I couldn’t afford to see a doctor without my health insurance,” she said. “I barely make ends meet now, and I don’t make enough money to pay full price for insurance. I bring home less than $1,300 a month after taxes, and health insurance would eat most of that up if I didn’t get government help.”
It doesn’t matter that the government is not paying her insurance company; the ACA requires her health insurer to reduce her premiums because her income is less than 250 percent of the poverty line, which is $12,600 for individuals.
People who make less than $25,000 per year qualify for lower premiums and out-of-pocket medical costs under the ACA, regardless of what President Trump does to insurance payments. The amount is 250 percent of the poverty line, which was $12,600 this year for a single person.
For the people who qualify for the biggest reductions, their health insurance deductible — the out-of-pocket cost — can drop from about $3,600 a year to $250 because of discounts under the ACA.
(Two or more people in a household qualify for discounts at higher income levels depending on age and family size because the poverty line is based on income and family size.)
Ms. Hankin estimates that of the 390,000 Virginians who bought insurance through the ACA, about 80 percent, or around 312,000 people, would continue to qualify for tax credits, and of those, about 243,000 people also would qualify for tax credits and reduced premiums based on their age and income.
The impact of the president’s action will hit hardest at households with higher incomes who do not qualify for any subsidies, Ms. Hankins said.
Currently, subsidies go to people at or below 400 percent of the poverty line, including couples with a household income of $64,000 or less a year and a family of four with a household income of $98,000 or less. Those making more do not qualify.
And those premium hikes will be substantial when 2018 arrives, according to the State Corporation Commission’s Bureau of Insurance.
Premium costs already had been expected to increase between 10 percent and 54 percent for 2018, based on early summer filings from the seven companies that are still offering health insurance through the ACA exchanges, the bureau noted.
But in August, in preparation for the loss of federal cost-sharing payments, the insurers revamped their rates at the SCC’s request, the bureau stated. Now the average increase is running between 51 and 67 percent, with increases of 160 percent to 265 percent on some policies, the bureau stated.
The average cost for a policy under the revamped and higher rates is projected to average $668 a month to $1,031 a month per person, depending on the company and the policy, the bureau stated in a Sept. 27 report.
The uncertainty is whether those who get no subsidies for purchasing an individual or family plan will drop coverage because of the expense, leaving only sicker, older patients and those qualifying for subsidies in the pool of those buying health care coverage.
Ironically, the president’s action will end up costing the federal government an extra $2 billion to $3 billion a year in increased subsidies to cover the cost of tax credits, asserted Matt Fiedler, a fellow with the Brookings Institute in Washington.
He said that the government has been spending about $7.7 billion a year to provide tax credits.
As the premiums go up, Mr. Fiedler noted, the government would need to come up with additional tax dollars to cover the higher premium cost for those who qualify for the credits.
Free Press wire reports
The Senate authors of a bipartisan plan to restore subsidies to insurers to reduce the cost of health insurance to lower income buyers involved with the Affordable Care Act are losing momentum and would need significant help to get their proposal through Congress.
The prospect the president would sign such a bill, even if it passed the Senate and House, also has dimmed.
“If something can happen, that’s fine,” President Trump told reporters Wednesday at the White House, just a week after creating the turmoil for people who buy insurance through ACA markets under the program former President Obama spearheaded.
“But I won’t do anything,” President Trump said, “to enrich the insurance companies because right now the insurance companies are being enriched. They’ve been enriched by Obamacare like nothing anybody has ever seen before.”
The proposal from Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., calls for a two-year extension of federal subsidies to insurers that President Trump has blocked.
GOP co-sponsors include Sens. John McCain of Arizona, Lisa Murkowski of Alaska and Tennessee’s Bob Corker. Sen. Mike Rounds, R-S.D., said Sen. Alexander has eight or nine Republican co-sponsors, and Democrats plan to provide an equal number to build bipartisan pressure.
Supporters of the Alexander-Murray measure also include America’s Health Insurance Plans, the giant trade group for insurers; AARP representing the elderly; and the National Retail Federation, which lobbies for merchants plus doctors, hospitals and patients groups.
But the promising proposal already has secured an important new foe. The anti-abortion National Right to Life group said it opposed the measure because it lacked language barring people from using their federally subsidized coverage to buy policies covering abortion, said Jennifer Popik, the group’s top lobbyist.
In another blow, Doug Andres, spokesman for House Speaker Paul Ryan, R-Wis., said the speaker “does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare.”
With hard-right conservatives wielding considerable influence and unwilling to prop up President Obama’s health care law, it appears Speaker Ryan would be unwilling to even bring the measure to the House floor even if it passed the Senate.
Overall, it was a bad day for the bipartisan accord, with several Republicans conceding that it likely needed the president’s backing to survive.
“Without the president supporting it, I don’t think you have the votes in the House or the Senate,” No. 3 Senate GOP leader John Thune of South Dakota said.
Sens. Alexander and Murray shook hands on their agreement this week after months of intermittent talks.
Failure to restore the federal payments to insurers could result in higher premiums for millions of people who buy their own individual policies and drive more insurance carriers from unprofitable markets. Many in Congress would love to avoid blame for two such tumultuous events.
The federal money reimburses carriers for lowering co-payments and deductibles for about 6 million lower-income customers, which the companies must do under Mr. Obama’s statute.
Without those funds, insurers would likely boost premiums by an average 20 percent, the nonpartisan Congressional Budget Office has projected. This would especially hit many who make too much to qualify for tax credits that help reduce premiums for people who make lower incomes. Tax credits to reduce premiums end for a family of four with household income above $98,000, for example.
Insurers in Virginia and other states already have installed higher premiums for next year, anticipating the subsidies would end.