ACA Update April 6, 2017

Will the cost-sharing reductions feature of Obamacare remain intact?

This feature of the ACA provides a subsidy to people whose incomes fall below 250 % of the poverty level to help them pay for deductibles and co-pays. It is also a revenue stream for health insurers who hope to receive more than $15 billion in the next two years to help off-set costs associated with providing coverage to low-income consumers. In the pending House v. Price suit (formerly House v. Burwell), the GOP sued to eliminate this revenue to carriers, calling it “illegal” outside of the appropriations process. A delay was granted until after President Trump’s inauguration, and the GOP hopes that they can come up with repeal and replace legislation that will allow for a resolution of the suit.

According to the Kaiser Family Foundation, approximately 20% of consumers – or 1 in 5 – will be left with only one option for healthcare in 2017.

Despite the Obama administration’s assurance of the availability of coverage options, this number is an increase over 2016 when only 2% of consumers had limited options. Insurers will be finalizing their decisions as to whether or not to participate in the exchanges next year, as filing deadlines approach in the next quarter across the country – however, last week Trump proposed to allow more time for insurers to price their products for the coming year.

Last year, Arizona became the first state in which an entire county was without health plan options.

Aetna, in a last ditch effort by state and federal regulators, was coaxed to bring one of the Blues back into Pinal County. However, Humana has announced they plan on exiting the Knoxville, Tennessee marketplace in 2018, which will potentially leave tens of thousands of consumers with no options to purchase coverage with a subsidy.

The future of some big players in the Marketplace remain in limbo after the GOP tabled a vote on the Obamacare replacement, the American Health Care Act (AHCA), or Trumpcare.

The lack of support for the new plan has Anthem, Blue Cross and Blue Shield, and others unsure of whether or not they will participate in the exchanges next year. In some states, the Blues – sold under various regional plan names – are already announcing they won’t sell or renew plans after January 1, 2018.