Okanogan County residents could see big cost increases
By Marcy Stamper
Although the open-enrollment period for health insurance is just two weeks away, uncertainty — about costs, subsidies, and what the policies will actually cover — is still growing.
Just last week, President Donald Trump issued two declarations that could affect how health-insurance plans purchased through the Health Benefit Exchange, Washington’s marketplace for the Affordable Care Act (Obamacare), actually function.
Among the changes Trump announced are the discontinuation of the cost-sharing program that helps lower-income people pay for health care by reducing deductibles and co-pays. The cost-sharing reductions are separate from tax-credit subsidies for premiums, which are not affected by the president’s action.
“The hard part is, as soon as [each new development] comes out, it may be irrelevant, because of the political ping-pong match,” said Jeff Lindstrom, an insurance adviser with
Seattle-based Health Insurance Team and a certified broker through the exchange.
Over the past three years, as insurers who sell policies in Washington found they were losing money in the individual market, they’ve cut back on coverage, said Lindstrom. The individual market includes people who buy their own policies through the exchange or outside it.
“There are no PPO plans left anywhere in Washington for individuals,” said Lindstrom. PPO plans offer a large network of providers that let people choose a doctor or specialist without a referral. In fact, almost no insurers in the individual market in Washington include coverage for an out-of-state network, which means that anyone who gets sick or has an accident out of state will be on the hook for a big chunk of his or her medical care, he said.
The cost-sharing subsidies have been targeted because Congress didn’t include money for them in the Affordable Care Act, said Lindstrom. Instead of fixing that, Pres. Obama authorized the payments through an executive order. Obama’s order was challenged in court by Republicans, and Pres. Trump has now reversed it.
The reduction in cost-sharing takes effect immediately, but health-policy analysts aren’t sure who will bear the brunt of that change. Although the executive order cuts off reimbursements to insurers, the Affordable Care Act requires those cost-sharing payments to be made to people who qualify.
Insurance companies will have to find another way to cover these costs, and many policy analysts expect the companies will raise premiums. That could affect people who buy their coverage through the exchange but earn too much to qualify for a subsidy, according to the Kaiser Family Foundation, a nonprofit organization that provides information on national health issues.
On Tuesday (Oct. 17), Senator Patty Murray (D-Washington) and Sen. Lamar Alexander (R-Tennessee) reached a deal that would fund the cost-sharing subsidies for two years. The deal is intended to stabilize health insurance markets by providing more certainty to insurance companies.
Trump said the effort could be a “short-term” solution. The deal would still need to be approved by the full Congress.
Other changes announced by Trump could threaten the essential benefits insurance companies have been required to cover, including contraceptive coverage for women.
Last week, Washington Attorney General Bob Ferguson joined 19 states in a lawsuit seeking to force the Trump administration to continue paying the cost-sharing subsidies. The lawsuit contends that Trump’s decision to withhold the payments is illegal and unconstitutional.
The week before, Ferguson sued the Trump administration over rules that would allow a company to deny coverage for contraceptive services to female employees based on religious or moral grounds. Ferguson argued that the contraception rules violate the Constitution.
Understanding the changes
Room One, the nonprofit social services agency in Twisp, has been helping people navigate the health insurance marketplace — with specially trained navigators — for years, but the agency’s staff are still trying to get a complete understanding of who will be affected by the executive orders and what those effects will be. But they’re clear on one thing: “There will be serious changes to health-insurance plans in Okanogan County — they will be substantial,” said Elana Mainer, Room One’s executive director.
Although insurance plans change every year, this year the changes are bigger, said Maureen Collins, a client advocate at Room One who is also certified as a navigator to assist people with health coverage.
“Folks who need health insurance — who have things they need care for — are worried, particularly about the threat of taking away coverage for pre-existing conditions,” said Collins.
Although the state hasn’t released details of insurance plans for next year, Room One anticipates premiums will increase 15 percent for policies sold within the exchange, and 20 percent outside the exchange. Some predictions go as high as 40 percent, said Mainer.
Details on all health plans and premiums for 2018 must be posted at the same time, and plans submitted by companies that want to sell outside the exchange are still under review, said Stephanie Marquis, a spokesperson for the state Office of the Insurance Commissioner. The information will be available as of Nov. 1, when the open-enrollment period begins.
Because of the uncertainty that has surrounded the health insurance market all year, Kreidler asked insurers to submit two sets of rates — with and without the federal cost-sharing contribution — and approved both schedules, said Lindstrom. Since the rates haven’t been published yet, insurers can still switch to the higher rates to cover their costs, he said.
Premiums are set by the companies in conjunction with the insurance commissioner, who has to balance huge increases with the need for insurance companies to break even so that they continue to offer policies to Washingtonians, said Lindstrom.
The insurance commissioner has released basic information about plans that will be sold on the exchange, which is where people can obtain subsidies. In Okanogan County, two companies will sell through the exchange, down from three last year. Lifewise Health Plan of Washington will sell four policies, and Premera Blue Cross will offer seven. In addition, Asuris Northwest Health has proposed to sell five plans outside the exchange in Okanogan County, said Marquis.
Molina Marketplace, which Mainer said offered the most affordable and comprehensive plan in the county last year, has pulled out.
Another rate increase this year comes in the premiums charged for people who have children on their individual plans. (This doesn’t include those in Apple Health, which covers people who earn up to 400 percent of the poverty level.) In the past, individual plans covered all children — from birth to age 20 — at one rate, but insurers now raise rates each year starting when a child reaches age 14, said Lindstrom.
“A lot of folks are concerned they won’t have health insurance next year — that they won’t be able to afford it,” said Collins. When some people compare how much they pay for premiums versus how much they actually use their health care, they may forego coverage altogether, she said.
Some changes made to Obamacare are likely to affect access to health coverage in other ways. The open-enrollment period has been shortened. Anyone wanting to choose a new plan has only from Nov. 1 through Dec. 15 to research and select a plan for coverage starting Jan. 1, 2018. People who sign up between Dec. 16 and Jan. 15 will be covered starting Feb. 1. In past years, open enrollment ran through the end of January.
“When we have so many serious health challenges across Okanogan County, these changes make a difference,” said Mainer.
“I’m telling my clients, ‘Turn off the news, stop paying attention, and let’s talk in November and see what’s happening,’” said Lindstrom.
People who need help with health insurance can call Room One at 997-2050 to make an appointment or to be connected with a broker.