The uncertainty of the Affordable Care Act, or Obamacare, at the federal level has already impacted San Juan County.
Starting in 2018, only one insurance company, Kaiser Foundation Health Plan of Washington, will offer individual plans in the county, whether on the ACA marketplace or outside.
Last year, county residents could choose from Kaiser for single-person plans inside and outside the marketplace; they could also select individual Regence Blue Shield plans outside the exchange.
Regence Blue Shield officials stated they would leave individual markets in 19 Washington counties, last summer.
“What we’re told by the company, is that they really couldn’t calculate [loss] because of the instability of the market thanks to the Affordable Care Act,” said Gigi Zakula, agent and owner of Islanders Insurance in Friday Harbor.
Zakula noted her company is transitioning about 50 locals off Regence Blue Shield plans, as a result.
“Unprecedented uncertainty at the federal policy level has led us to make some difficult decisions about our participation for 2018,” reads a statement from Regence officials.
That “unprecedented uncertainty” came to a head on Thursday, Oct. 12, when the Trump Administration released plans to withhold reimbursements to insurance companies, which cover ACA’s discounted plans. Exact details of the plan have yet to be released.
The industry calls these reimbursements “Cost-Sharing Reduction payments,” or CSRs, which is a key component of the legislation. The federal government reimburses insurance companies for the subsidies they provide to low-income ACA customers.
The ACA offers affordable health insurance to more Americans by providing subsidies to purchase plans and expanding coverage of Medicaid, or Apple Health in Washington, which offers free or discounted insurance for the low-income and disabled.
Since last summer, President Donald Trump threatened to cut these reimbursements to insurance companies if a new health care bill wasn’t approved by Congress. Since Congress has yet to do so, Trump’s plan takes steps to dismantle the act.
Officials from Washington’s state-run ACA marketplace released premiums and deductibles for plans in September before the marketplace opens on Nov. 1. In the highest cases, mid-priced 2018 county ACA plans show a projected $150 increase without CRS funds.
Without the loss of CSRs, the most affordable monthly ACA plan in the county for 2018, is a bronze level plan of $264 a month with a $7,150 deductible. The most expensive monthly plan is a gold level plan of $453 a month with a $850 deductible.
Anyone can purchase plans through the marketplace, but discounts are given based on income from the prior year’s tax returns. Zukala said premiums, which are usually monthly payments, are about the same outside the marketplace, though no discounts are provided.
About five insurers have been offered to county residents on the state’s ACA marketplace, at differing times, said Zukala, since the act went into effect in 2014. This includes today’s lone insurer on the marketplace — Kaiser Foundation Health Plan of Washington, formerly known as Group Health.
Of the 39 counties in Washington, San Juan County is one of nine that will offer one insurer through the state’s ACA marketplace called the Washington Health Benefit Exchange.
Last year Premera Blue Cross chose not to offer individual plans, both inside and outside on the marketplace, in San Juan County. Officials stated the rural area’s limited health care providers were outside the company’s preferred network, which offers cost breaks. Under ACA, insurance providers cannot legally refuse to cover the sick, who cash in on coverage more than the healthy, costing insurance companies more money.
Even before the anticipated loss of CSRs, deductible ranges rose for 2018 ACA plans across the state. Deductibles have to be paid before insurance companies compensate claims.
Before the loss of CSRs, the maximum deductible range for gold plans increased $2,260 and the minimum for silver plans increased $1,750, while bronze plans remained the same.
Bronze plans have the most affordable ACA premiums, offering higher deductibles and paying less coverage than the more expensive premiums of silver, then gold. Unlike seven Washington counties, ACA’s three levels of plans will be available in San Juan.
As of now, the 2018 marketplace will offer one less silver plan and two additional bronze plans for San Juan County than last year. Compared to 2016, next year’s marketplace will offer 13 fewer gold plans, 19 fewer silver plans and 12 fewer bronze plans for county residents.
Though plans and insurance providers have decreased, county enrollment in the marketplace has almost doubled since it opened in 2014; it fluctuated only a few hundred subscribers over the last three years. Enrollment increased 23 percent in the state from the year before.
The marketplace’s open enrollment for most states runs from Nov. 1 through Dec. 15 to be covered by Jan. 1. This is also true in Washington, but enrollment has been extended to Jan. 15 to cover subscribers by Feb. 1 as well.
A representative with the state exchange said Washington’s marketplace has more flexibility to extend enrollment than states using the federally facilitated marketplace. This is the first year staff for the Washington marketplace has advertised a longer enrollment period.
There are 12 state-run ACA marketplaces for 2018, including in Washington.
Affordable Care Act Enrollment
Enroll from Nov. 1 to Dec. 15 to be covered by Jan. 1
Enroll by Jan. 15 to be covered by Feb. 1.