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Washington – Millions of people covered under the Affordable Care Act will see only modest premium increases next year, and some will get a price cut. That’s the conclusion from an exclusive analysis of the besieged but resilient program, which still sparks deep divisions heading into this year’s midterm elections.

The consulting firm Avalere Health and The Associated Press crunched available state data and found that “Obamacare’s” health insurance marketplaces seem to be stabilizing after two years of sharp premium hikes. And the exodus of insurers from the program has halted, even reversed somewhat, with more consumer choices for 2019.

The analysis found a 3.6 percent average increase in proposed or approved premiums across 47 states and Washington, D.C., for 2019. This year the average increase nationally was about 30 percent. The average total premium for an individual covered under the health law is now close to $600 a month before subsidies.

For next year, premiums are expected either to drop or increase by less than 10 percent in 41 states with about 9 million customers. Eleven of those states are expected to see a drop in average premiums. In six other states, plus Washington, D.C., premiums are projected to rise between 10 percent and 18 percent.

Michigan residents will pay an average of 1.4 percent more in 2019 for health plans purchased at HealthCare.Gov, according to preliminary rates from the Michigan Department of Financial and Insurance Services. That’s far less sticker shock than in 2018 when premiums increased by 27.6 percent over the previous year.

“(Last year) there was a lot of uncertainty for insurers,” said Maggie Randolph, a senior research analyst with the Center for Health Care Research and Transformation at the University of Michigan. “This year that’s been tempered a bit.”

Much of that uncertainty was due to the loss of federal cost-sharing payments to health insurers, eliminated in an executive order by President Donald Trump in October 2017, and tax penalties for the uninsured, which were abolished by Congress in December 2017.

Last year, 86 percent of Michigan residents who bought plans at HealthCare.Gov qualified for federal advanced premium tax credits that helped cover the cost of the rate increases, Randolph said. The people who felt the brunt were those who didn’t qualify for the federal subsidies.

“Hopefully there will be more of those individuals who will buy plans in the individual market (this year) because it’s not going to be as extreme as it was last year,” Randolph said.

Insurers are starting to come back. Nineteen states will either see new insurers enter or current ones expand into more areas.

Even so, Chris Sloan, an Avalere director, says, “This is still a market that’s unaffordable for many people who aren’t eligible for subsidies.”

Nearly 9 in 10 ACA customers get government subsidies based on income, shielding most from premium increases. But people with higher incomes, who don’t qualify for financial aid, have dropped out in droves.

It’s too early to say if the ACA’s turnabout will be fleeting or a more permanent shift.

April Box of Spokane Valley, Washington, lives in a state where premiums could rise substantially since insurers have proposed an 18 percent increase. In states expecting double-digit increases, the reasons reflect local market conditions. Proposed increases may ultimately get revised downward.

Box is self-employed as a personal advocate helping patients navigate the health care system. She has an ACA plan, but even with a subsidy her premiums are expensive and a high deductible means she’s essentially covered only for catastrophic illness.

“I’m choosing not to go to the doctor, and I’m saying to myself I’m not sick enough to go to the doctors,” Box said. “We need to figure out how to make it better and lower the price.”

“It needs to be a level playing field for everybody,” said Box.

Detroit News Staff Writer Karen Bouffard contributed.

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