Now that the nation has settled into the reality that the
Affordable Care Act (ACA) is not going away, at least anytime soon, the
challenge of providing affordable health insurance options through Healthcare.gov
and some of the state marketplaces remains apparent. Of course, if you qualify for a premium
subsidy or cost sharing subsidy, the costs are much more tolerable, however,
you must be able to substantiate your income, or lack thereof, through your
federal tax return. As of the end of the
summer, it was projected that as many as 1.5 million persons who had received a
premium subsidy in 2014 had not filed tax returns.
The challenge is complex, as the cost of sending young
adults to medical school, the cost of medical equipment, drugs, research and
development and administration associated with all of the required protections
and technology are not cheap. They will
undoubtedly continue to rise. Here are
some hard and fast stats on what’s happening in some of the states regarding
projected premiums for 2016:
· Florida
has approved an average 9.5% increase in its individual marketplace plans. While some have actually decreased, Aetna
requested a 20.9% increase and was approved by state regulators for a 13.9%
increase. The ACA marketplace plan
offerings range from a 9.7% decrease by Florida Health Care Plan to a 16.4%
increase by United Healthcare of Florida.
(Florida Office of
Insurance Regulation via The Wall Street Journal and the Orlando (FL) Sentinel)
· Iowa’s
largest insurer, Coventry Health Care, was approved for a 19.8% increase. Wellmark Blue Cross and Blue Shield was also
granted an increase. It is projected that the rate increase will affect
35,000-47,000 policyholders. (Iowa Insurance Division via The Des Moines
Register and The Quad-City Times)
· The
average increase in Idaho is approx. 23% across the Blue Cross of Idaho Health
Service plan offerings. The increases
were deemed reasonable after review by the Idaho Director of insurance. (Idaho Officials via the AP)
· Increases
up to 25.4% have been approved in the state of Kansas. (AP)
·
Blue Cross and Blue Shield of N. Mexico has
pulled out of the N. Mexico ACA Marketplace after not being able to reach an
agreement on rate increases with state regulators. BCBS of N. Mexico lost $19.2 million on
35,000 individuals covered during the last year. (Albequerque
(NM) Journal)
· The
Nevada Health Plan COOP, one of the state based non-profit entities that was
authorized to use federal funds to start up a health plan under the ACA, has
decided to close. Co-op CEO Pam Egan “said in a
statement that a second year of high claims costs and limited growth
projections for enrollment made it ‘clear’ that the insurer would have a hard
time providing ‘quality care at reasonable rates’ in 2016.” Nevada Health CO-OP
reported a $19.3 million operating loss last year and a $3.5 million loss in
the first quarter of 2015, according to documents filed with the Centers for
Medicare and Medicaid Services. (Las Vegas Review-Journal)
Not mentioned often enough is that the trend for more
affordable health insurance options is through the utilization of narrow
networks. In a nut-shell, a narrow
network is simply a limited choice of providers for your medical needs. As an example, 5 out of 6 Georgia ACA
Marketplace plans in the “Silver” category provide networks with a limited
choice of doctors when compared to the larger networks available through plans
offered outside of the Marketplace. (Atlanta Journal-Constitution) While
Georgia’s limited network situation seems to lead the nation, most states have
similar circumstances in the most affordable premium categories.
The Affordable Care Act certainly has expanded the
availability of health care options to many.
Like any other entitlement, it comes with a cost and sacrifices. Taxes and fees associated with the ACA are
abundant and add to the cost of providing insurance. Additionally, the infamous “Cadillac Tax,”
planned to take effect in 2018, will impose an excise tax on companies that
provide a plan deemed “To rich” based on
annual premiums. This tax is receiving
much attention in the coffers of the House and Senate as it is projected to affect
1 in 4 employers. The tax is 40% on
amounts over the threshold.
Therefore, be prepared to continue to navigate
through the rough waters of reality as you analyze your health insurance
options. There is plenty more to
discuss, however, that is enough for now.
There will certainly be some squalls in the seas of change as we continue
through the many challenges that lie within the act.
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