The health 202: the good, the bad ... and the truth about obamacare signup season
Please subscribe and enjoy more: PROGNOSIS The sixweek enrollment period for 2018 Obamacare coverage starts today. Joe RaedleGetty Images Want more inside information on health care policy in the Trump era? Get it here. You’ll hear two competing narratives over the next six weeks, as Americans without employersponsored coverage buy plans on Healthcare.gov and staterun marketplaces during the Affordable Care Act’s fifth signup season. Here they are Narrative 1 Obamacare was working beautifully until President Trump and his Republican cronies sabotaged the law, pushing up premiums, driving insurers away and confusing people about whether the ACA even exists anymore. Narrative 2 Obamacare is in an unavoidable death spiral because it’s a fundamentally flawed law, forcing up premiums and reducing choices for consumers who are losing out big time under it. The truth is, neither narrative is entirely correct, despite what you might hear from relatives around the Thanksgiving table a few weeks from now. The Trump administration — according to the way it has framed this year’s diminished options and higher premiums — would have you believe the situation is unavoidably out of its control. The sharp contrast between how its handling things and how the Obama administration approached the marketplaces has been clearer than ever over the past few days. Were the prior administration around, the Department of Health and Human Services would be stressing that most consumers are sheltered from premium hikes because of federal subsidies. Its top officials would be fanning out across the United States to hold outreach events. But this week, representatives of HHS and the Centers for Medicare and Medicaid Services didn’t respond to questions about whether their leaders — Eric Hargan and Seema Verma — have events planned today to mark the first day of open enrollment. Democrats, dismayed at the prospect that recent coverage gains under the ACA could be reversed, are accusing the administration of hurling a wrecking ball at an otherwise healthy individual market. Several groups that have sprung up to defend the law from GOP attacks — many of them run by Obama appointees or Democratic operatives — are heaping blame on Trump for unaffordable premiums. “While many Americans will pay more due to President Trump’s sabotage, millions of Americans can still find affordable health coverage,” Protect Our Care Director Brad Woodhouse said in a statement yesterday. A sign on an insurance store advertises Obamacare in San Diego. REUTERSMike Blake Let’s eat some reality pie The truth lies somewhere in the middle. The administration could be doing a lot more to support the marketplaces. But the marketplaces have also failed to attract the healthy mix of enrollees needed to keep prices lower. Here are three things to watch during enrollment season which starts today and ends Dec. 15 1. The enrollment number to beat or fall short of is 12.2 million. That’s how many people selected a marketplace plan during 2017 enrollment. Most experts have predicted that signups will be significantly less this year — perhaps by as much as 1 million — given the administration’s cuts to advertising and outreach and only six weeks for consumers to enroll instead of three months. 2. Obamacare is getting cheaper for people whose low income qualifies them for premium subsidies. About 80 percent of marketplace enrollees will qualify for the federal assistance, up from 71 percent last year, according to numbers from CMS. This seems counterintuitive, right? After all, Trump cut off extra costsharing payments for insurers, prompting them to raise premiums even more to make up the difference. But that’s precisely why the premium subsidies are getting more generous. They’re based on the cost of a midlevel “silver” plan. And because silver premiums are rising, subsidies are, too. 3. But fewer people ineligible for subsidies are buying individual plans. They could drop off even more as premiums go up because these folks aren’t sheltered from the increases. This year, 5.4 million people bought their health insurance outside the ACA marketplaces. You can’t get subsidies off the exchanges, so these shoppers were presumably higherincome earners who can’t get the federal assistance anyway. But this number has been declining dramatically. Even though the marketplaces got 3.8 million new enrollees for 2017, individual market enrollment actually fell by 12 percent overall, according to a July report by Mark Farrah Associates. The moral of the story? Obamacare coverage is totally affordable if you get help from the federal government in buying it. But if you don’t get help, buying that coverage is a lot harder. New Jersey Gov. Chris Christie R. AP PhotoMel Evans, File AHH Trumps opioid commission will issue a final report today calling for big boosts in substanceabu
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