As Republicans try to repeal the Affordable Care Act (ACA), it’s important to remember that policy decisions about the marketplace are being made simultaneously, which will impact nearly 22 million people.
The ACA is still the current health law of the land. Because of this, state lawmakers and insurance companies need to maintain daily health operations and that means preparing for open enrollment, slated to begin November 1 — just a month away.
In order to prepare, state officials need to work with insurance companies, set premium prices, and promote the ACA marketplace. The current state of uncertainty coming from Washington D.C. is making it challenging to do just that.
“Insurance companies are being asked to make decisions without knowing the rules of the road,” said Elizabeth Carpenter, senior vice president of policy practice at the health consulting firm Avalere. The innocent bystanders being affected by that reckless planning? Anyone who enrolls in the ACA individual and small group marketplace.
Wednesday is the deadline for insurance companies to file premium rates for plans they intend to sell on Healthcare.gov in 2018. States need to send the Centers for Medicare and Medicaid Services (CMS) Health Insurance Oversight System prices amid ongoing national policy debate over the mere existence of the ACA.
That presents a major problem.
During any other year, for instance, the Oregon Health Insurance Marketplace would have sent CMS its premium rates the first week of August, signaling prices to consumers early. “The uncertainty had us wait to file until the very last day,” Jake Sunderland, public information officer for the state agency, told ThinkProgress.
The Oregon Health Insurance Marketplace filed prices Wednesday to reflect the current law of the land as it stands today. Prices haven’t changed from those posted in July. Seven companies will participate in the ACA marketplace in Oregon, with average rate changes ranging from a 1.6 percent decrease to a 14.8 percent increase. Most enrollees will be safeguarded from steep increases because of federal subsidies.
Across the country, insurance companies — pending state government approval — have also been requesting high premiums for next year, and many have been quite explicit that they’re doing so largely out of uncertainty fueled by the Trump administration.
Looking to offer assurances to the states, the Senate’s Committee on Health, Education, Labor, and Pensions (HELP) held hearings, hoping to draft bipartisan legislation by the end of September. The senator leading those efforts, Sen. Lamar Alexander (R-TN), announced Tuesday evening that negotiations had been paused indefinitely, noting that the committee had not “found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted.”
Bipartisan negotiations on Obamacare are dead after repeal comeback pic.twitter.com/fTZwG9a1b9
— Benjy Sarlin (@BenjySarlin) September 19, 2017
The bipartisan health bill would have likely included cost-sharing reduction payments to insurance companies for at least one year, which are currently being made by the White House on a month-to-month basis. The Trump administration agreed to make these payments for the month of September, but the lack of commitment and seemingly deliberate sabotage stemming from the White House, compounded by ardent congressional efforts to repeal current health law, is worrying many state officials who are trying to make sure people have affordable insurance next year.
Among those attempting to replace the current health care law is Sen. Bill Cassidy (R-LA), who has been making the rounds on morning talk shows recently, selling his Graham-Cassidy Obamacare repeal plan which he says would make insurance more affordable. On CNN’s New Day, he defended himself from critics who said his plan would hurt Americans, saying,
In regards to affordability, there’s a fellow with a daughter with a pre-existing condition, and under Obamacare his premium is over $40,000. Obamacare doesn’t work if you work. If you make too much money to qualify for a subsidy, you get stuck. We are helping those families, we are not penalizing because they cannot afford a premium which is too rich for them.
The truth is, Cassidy’s ACA repeal-and-replace bill will not only have a negative effect on consumers and patients, it’s also effectively killed bipartisan health talks, the only hopes for stabilizing the marketplace in 2018, and has made the health industry uneasy again (health stocks took a hit Tuesday in light of the bill’s revival).
In a press release Wednesday, officials from the country’s oldest and largest insurance company, the Blue Cross Blue Shield Association, said they had shared “the significant concerns of many health care organizations about the proposed Graham-Cassidy bill.” Specifically, they stated, it would increase uncertainty and make coverage much more expensive.
“The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions,” they wrote. “…The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans.”
The lack of attention being paid to the current health care law is also troubling advocates. Rhonda Henry, founder of the Indivisible ACA Signup Project, which focuses on informing consumers about the ACA, is specifically concerned that attention on Graham-Cassidy may be giving potential enrollees the impression that the ACA has already been repealed.
“The reality is, as Graham Cassidy get more press attention, it really hurts ACA enrollment,” said Henry. “Even if we kill this bill, there will be so many folks who believe ACA is dead. And sadly, they’re likely to be the young and healthy people — the ones that really make the ACA work.”
Henry — who refuses to be discouraged — has said the Indivisible ACA Signup Project will remain mission-focused as long as the ACA is the law of the land. Additionally, she encouraged those who are concerned to join a partnership Facebook group, Saving Affordable Health Insurance, in order to understand what’s happening.
For now, advocates say they’re doing what they can to keep things afloat and ease the public’s anxiety. “We are closely following the federal discussion about the future of our nation’s health care system to determine what the impact will be on Oregonians,” Sunderland said. “In the meantime, we are doing what we can to support a competitive and stable health insurance market within the current laws and preparing for the 2018 open enrollment season.”