Uncertainty influences early premium rate filings for ACA exchange plans
- Benchmark premiums for Affordable Care Act (ACA) exchange market plans will change in a range from 49% higher in Wilmington, Del., to 5% lower in Providence, R.I., according to a new Kaiser Family Foundation (KFF) analysis of early rate filings.
- A single adult making $30,000 a year who buys the second-lowest cost silver plan next year will pay about $200 a month, according to the report.
- The CMS announced on Thursday it is extending the deadline for insurers to file their rates to Sept. 5. Payers no longer have to decide next week.
Participation and premium rates in the exchange markets continue to change as payers are hoping to receive word from the White House or Congress about whether cost-sharing reduction (CSR) payments to them will continue.
Payers are highly concerned about the CSR payments, and have been pleading with President Donald Trump’s administration or Congress to assure they will continue. They have frequently warned that without the CSRs, premiums are likely to increase drastically. Several insurers have chosen to exit or scale back participation in the exchanges because of the uncertainty and the destabilizing affect it has.
KFF looked at the premium rates filed so far in 20 states and the District of Columbia. It notes that the data are preliminary and can change. In those areas, an average of 4.6 insurers intend to participate in the exchange next year, a decrease from 5.1 this year and 6.2 in 2016.
Many payers have filed detailed requests, and some presented the rates that would be needed for different scenarios, including little or no enforcement of the individual mandate and no CSR funding. The changes that would results vary widely among payers and regions, but payers say no mandate could increase rates by up to 20% and no CSRs could increase them by up to 38%.
Some lawmakers would still like to use legislation to fund the CSRs. Several draft bills for full or partial repeal of the ACA included the funding, but all the larger efforts regarding the ACA this session has failed. Payers are running out of time to make any changes to rates or participation in the exchanges. They must sign annual contract with Healthcare.gov by the end of September.
There is also a lawsuit still pending that could affect CSRs. The Trump administration has yet to say whether it will continue to defend the case, which was first brought against President Barack Obama. At that time, House Republicans filed a suit claiming the CSRs were being illegally paid with funds not appropriated for that purpose.
Most marketplace enrollees won't experience the increases first-hand, because premium tax credits rise with the premium rates. That means the rate increases do, however, cost the federal government more money. The KFF report states: "Ultimately, most of the burden of higher premiums on exchanges falls on taxpayers. Middle and upper-middle income people purchasing their own coverage off-exchange, however, are not protected by subsidies and will pay the full premium increase, switch to a lower level plan, or drop their coverage."
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