4.2 million uninsured Americans could get a bronze Affordable Care Act plan for free, according to a new Kaiser Family Foundation analysis. An estimated 27% of patients currently going without insurance are eligible for a bronze plan with $0 premiums in 2019.
In Iowa, Nebraska, Delaware and Utah alone, almost 50% of potential marketplace shoppers will be able to get a 2019 bronze plan at no cost. The average bronze plan next year costs $339 in monthly premiums before any tax credits or subsidies.
Bronze plans have high deductibles (more than $6,200 a year, according to KFF), but they cover the 10 essential benefits required by the ACA. Open enrollment for marketplace plans ends Saturday.
Since deductibles and premiums are both skyrocketing in employer plans, the ACA exchanges may be looking a bit more tempting for cash-strapped Americans.
Still, enrollment in the ACA marketplace is lagging behind past years, according to the latest data released by HHS showing 4.1 million people have signed up so far.
That's down nearly 12% from the year ago period, according to Kaiser's Larry Levitt. He also noted new sign-ups are down nearly 20%.
Bronze plans are the most bare-bones coverage available under the ACA, but each bronze plan must cover essential services such as preventive, emergency and pregnancy care.
The poorest consumers who select a bronze plan in the marketplace are eligible to apply for premium tax credits, or subsidies that could cover their entire premium in 2019.
Many people eligible for a lower-tier bronze plan would be better moving up a rung to a more moderate silver plan, experts say, to wring the most value out of their insurance. They would have to pay part of the premium every month, but would be able to get subsidized help with their out-of-pocket costs.
Many low-income uninsured people would be better off paying a modest premium to enroll in a silver ACA plan with cost-sharing subsidies and a lower deductible than a zero premium bronze plan. But, at zero premium, a high-deductible bronze plan is certainly better than nothing.— Larry Levitt (@larry_levitt) December 11, 2018
The number of uninsured Americans decreased from more than 44 million in 2013 to just below 27 million in 2016, largely due to the impact of the ACA. Last year saw the first increase in the number of uninsured, a setback many chalk up to the Trump administration's ongoing attempts to undermine the law.
Ten percent of non-elderly Americans are still uninsured, according to KFF, and yet enrollment in the ACA marketplace is running roughly 10% lower than last year.
Lack of awareness is likely a big contributor to lower enrollment. The Trump administration drastically slashed funding to navigators, consumer assistance groups that help with ACA enrollment. CMS made only $10 million available for marketing for 2019, compared to 2018's $36 million and 2017's $63 million.
Outreach plummeted as a result.
Ironically, however, KFF says one of the reasons millions of low income Americans are eligible for free coverage is that the Trump administration canceled cost-sharing subsidy payments to insurers. Payers hiked silver premiums to compensate in a practice called "silver loading."
Since financial assistance increases when premiums rise, subsidies rose in tandem.