ACA enrollment begins as voters say health care is top concern

The sixth open enrollment period for the Affordable Care Act begins Thursday, as the future of the health care law, and its protections for pre-existing conditions, has emerged as a top concern for voters across the nation in the midterm elections.

In Connecticut, those who aren’t covered through their employment or government-run plans like Medicare and Medicaid are urged by officials at Access Health CT, the state’s ACA marketplace, to shop for a policy on the exchange from the two insurers that participate, Anthem and ConnectiCare.

Although premiums for many plans have risen slightly this year – largely because of rising health care costs, insurers say – consumers are encouraged to shop around this year because they may be able to find a plan with better coverage and lower out-of-pocket costs.

There will be much less “sticker shock” this year because 2019 premiums did not increase much in Connecticut or across the nation. In contrast, premiums rose sharply in 2018, largely because the Trump administration said it would end payments to insurers that allowed them to lower out-of-pocket costs for low-income customers.

“In 2018, premiums were much higher than they needed to be,” said David Anderson, research associate at the Duke University Margolis Center for Health Policy.

There are several changes to open enrollment this year. To encourage healthy people to sign up, the ACA used to impose a tax penalty on those who did not have health insurance. However, effective in 2019, Congress eliminated that penalty.

Connecticut exchange officials aren’t worried about the elimination of the tax penalty.

“We think that the value that we bring to the residents of Connecticut by providing access to quality and affordable health care, that’s what’s going to keep us moving forward, with or without a mandate,” said James Michel, the new CEO of Access Health CT.

Another difference this year is that Connecticut’s ACA marketplace is debuting a new online tool that will help customers shop around to determine which plan best fits their needs at the best cost.

That’s because pricing will change for existing plans and new plans will be offered for the first time. While some customers may see savings in their current plans in 2019, exchange officials said, others will not.

For instance, a 29-year-old Fairfield County man who paid $520 for his monthly premium for the cheapest silver plan in 2018 would see an monthly increase of $34 if he enrolled in the same plan next year. However,  the cheapest silver plan in 2019 — a different plan — would save him about nearly $120 each month.

Life changes such as a change in the size of a family, where people live, and changes to income, might also change the monthly cost of a plan.

The tool asks for certain demographic information and poses questions about doctors, prescriptions drugs and medical use.

Certified brokers are also available free-of-charge to help residents figure out which plans to enroll in next year. The brokers are available through the call center and across the state for in-person meetings.

This year’s open enrollment period is also shorter than all previous years.  It begins on Thursday, Nov. 1 and ends on Dec. 15 for coverage that begins on Jan. 1, 2019.  While, open enrollment is only open once a year, you can sign up during a special enrollment if you get married, have a baby or lose your current health insurance coverage.

During last year’s open enrollment, 114,134 people signed up for coverage. Currently, about 100,000 residents are enrolled in plans.

Another difference that could impact enrollment this year is that the Trump administration changed ACA regulations on short-term plans, which tend to be cheaper than others sold on the Access Health CT exchange.

The ACA allowed people to purchase these short-term plans, which usually lacked maternity, mental health, full drug benefit and other coverage, but limited their coverage period to three months. These policies were also not renewable.

But the Trump administration’s new rules, issued Aug. 1, allow for nearly a year’s coverage under a short-term plan. They also allow short-term plans to be renewed for up to three years.

Unlike other policies, short-term plans can bar coverage for people with pre-existing health conditions.

However, the Connecticut Insurance Department determined that state law prohibits exclusions for pre-existing conditions for any policy that has coverage of six months or longer.

Therefore, any short-term plans sold in Connecticut must cover pre-existing health conditions if their coverage periods are longer than six months.

Premiums could increase — or decrease

Many people who shop for a 2019 plan on Access Health CT will be eligible for subsidies that will offset any increase in this year’s premiums.

This year, about three-quarters of Access Health customers received discounts. Higher premiums from one year to the next will lead to higher subsidies. So, many customers receiving discounts probably will see a smaller increase than expected – or no change at all.

The ACA provides consumers with subsidies that lower premiums for people with incomes between 100 percent and  400 percent of the  federal poverty level, or $12,140 to $48,560 for an individual this year.

Access Health CT gave as an example a single man called Michael, who would be 44 years old next year and lives in Fairfield County.  Michael has an income that is 300 percent of the federal poverty level, approximately $36,180 this year. He would receive a subsidy of $266 a month next year to help him pay a $536 monthly premium, if he choses the cheapest silver plan.

Those who earn too much money to receive discounts may notice an increase – or a decrease — in their premiums. Access Health CT said that by county, average rates are decreasing in New London, Tolland, and Windham, and increasing slightly on average in the other counties.

The Affordable Care Act also provides low-income people with subsidies for out-of-pocket costs like co-payments and deductibles.  Individuals and families who are eligible to receive a premium tax credit and have household incomes up to 250 percent of the federal poverty level are eligible for cost-sharing subsidies — but they must purchase a silver plan.

Meanwhile, health care has emerged as a top concern for many Americans in the midterm elections. A recent Kaiser Family Foundation poll found it’s the top issue for Democrats and independents, not Republicans, but that’s been more than enough to propel health to the top of  the issue list in national polls, even ahead of the economy and jobs.

FYI you hosted a giant party on the White House lawn to celebrate repealing protections for sick people and taking health care away from 30 million Americans.

You might have forgot.

America hasn’t. https://t.co/b1MixIhjIa

— Chris Murphy (@ChrisMurphyCT) October 23, 2018

Democrats are blaming Republicans for their attempts to repeal the Affordable Care Act and for their support of short-term plans, both of which would endanger the protections people with pre-existing health conditions have now.  Democrats are also slamming Republican candidates in 20 states that have filed a lawsuit that would demolish the Affordable Care Act, and for saying they will try to repeal the ACA again if they bolster their majority in the Senate during the midterm election.

Republicans say they support keeping the ACA’s protections for people with pre-existing conditions, although insurers say that can’t be done without other provisions of the health care law in place or without sharply raising premiums on those customers.

Sen. Chris Murphy, D-Conn., recently hit back when President Donald Trump tweeted that the GOP was devoted to safeguarding health care coverage for people with pre-existing conditions.

“FYI you hosted a giant party on the White House lawn to celebrate repealing protections for sick people and taking health care away from 30 million Americans,” Murphy tweeted. “You might have forgot. America hasn’t.”

Anderson said the latest political skirmishes won’t do much to dampen 2019 ACA enrollment. That’s because the GOP lawsuit against the ACA isn’t likely to be fully decided right away, and any repeal effort won’t take effect until the next enrollment period.