Dive Brief:
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A new report by the Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute offered insights from insurance brokers and agents about how federal policy changes are reshaping healthcare coverage.
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One tenet of the Affordable Care Act was to improve access to care and health insurance coverage. However, brokers said healthy, higher-income Americans are being pushed out of the individual health insurance market by rising premiums, turning instead to cheaper policies with limited protections.
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Health insurance brokers expect other health plan options, such as short-term health plans, will gain enrollment, leaving those left in the individual market to shoulder higher premiums.
Dive Insight:
Published by the Robert Wood Johnson Foundation, the report explored how limited plan choices, narrow networks and rising unsubsidized premiums are affecting the individual market, including the ACA exchanges.
The report warned that unless states protect their ACA exchanges, those plans could face more instability and spiraling costs.
The report focused on six states — Georgia, Iowa, Mississippi, New Hampshire, Texas and Utah. They all have “fragile markets” and higher than average premium increases and loss of insurers, according to the report.
Significant premium increases, fewer plan options and narrow provider networks are leading people to drop ACA plans, especially higher-income and healthier consumers, who aren’t eligible for government subsidies. The ACA provides subsidies for people with individual insurance who are up to 400% of the federal poverty level.
They’re eyeing short-term plans and healthcare sharing ministries instead.
The ACA limited short-term plans only to young adults or people who couldn’t afford other coverage. The law also kept those plans to three months. The Trump administration is making changes to drive short-term plan enrollment, including allowing anyone to get a plan and extending them from three months to one year with the option of renewing them for a total of three years.
These plans are cheaper, but they don’t offer ACA protections. They often don’t provide coverage found in other plans, such as pre-existing conditions, mental health, maternity care and prescription drug benefits.
Brokers said they’ve also moved many people from individual plans to small-group market plans, which have lower premiums and wider networks. Some brokers spoke positively about the potential of association health plans, which the Trump administration sees as a key way to provide cheaper health insurance options.
Brokers also said people are interested in direct primary care arrangements, which are contracts between patients and a primary care provider, and fixed indemnity plans. They said marketing of healthcare sharing ministries and direct primary care arrangements are increasing.
Many healthcare experts are giving similar predictions about the ACA exchanges and individual insurance. The difference in this report is that the insights are coming from brokers. The brokers are working directly with Americans with individual insurance who are struggling with costs and looking for plans they can afford.
The year 2019 could bear out upheavals in the exchanges and individual market. With Congress spiking the individual mandate penalty in 2019 and the Trump administration expanding lower-cost plans with fewer protections, next year will be worth watching.