ACA Uncertainties Could Mean Fewer Eligible People Enrolling

Patient advocates sound alarm, saying policy stability and continued federal support are essential

In addition to fueling premium increases, uncertainty over federal healthcare policy is also prompting customer confusion that could limit the number of eligible people who obtain insurance coverage through the Obamacare marketplace in the coming year.

New Jersey patient advocates spoke out on Wednesday to encourage federal government officials to maintain the current policies associated with the Affordable Care Act and commit to funding cost-sharing subsidies that would provide $166 million to help low-income residents who purchase policies on the ACA exchange. While congressional efforts to replace the landmark law appear stalled, concern over these issues is already driving insurance companies to propose higher rates for the coming year.

The advocates, New Jersey Policy Perspective and Citizen Action, also urged federal leaders to maintain financial support and other resources they provided in past years to help conduct outreach and other efforts to enroll as many eligible residents as possible. Given President Donald Trump’s pledge to let the program fail, it is unclear how much his administration will commit to helping state officials and community organizations sign up patients this time around.

Smaller enrollment window

Enrollment for the ACA exchange — which enables low-income residents to purchase highly regulated plans and receive help paying premiums and co-pays — has traditionally run from November 1 through January 31. This year it will be open for only six weeks, closing on December 15, which federal officials have said would “provide sufficient time.” That means insurers have half the time to reach current customers, who must re-enroll each year, or sign up new patients, all at a time when confusion about the law remains high.

“The consumers are really the ones who are suffering,” said Maura Collinsgru, the healthcare program director for Citizen Action, which is launching a consumer awareness campaign to ensure people know the truth: “The ACA is still here, despite the rhetoric and attempts to undermine it, and it will and continues to be the law of the land.”

More than 266,000 New Jerseyans are now covered through policies purchased on the ACA marketplace, according to a new report from NJPP, which has tracked the impact of the landmark 2014 law. Eight in 10 of those individuals receive subsidies to help cover premium costs and 55 percent also get an average of $1,200 to offset out-of-pocket costs. (Another 550,000 residents are covered through the ACA’s Medicaid expansion.)

But a federal study released last fall found that despite these benefits, some 6.9 million Americans who are eligible were not re-enrolled in the program; this included 44,000 Garden State residents. And experts said these people tend to be the hardest to reach — impoverished, homeless, suffering from substance-use disorders and mental illness, or all of the above.

Connecting with the ACA

In the past, a group of four community organizations shared $1.7 million in annual funding to help connect Garden State residents with Obamacare, either through the Medicaid program (which is limited to those who earn up to 137 percent of the poverty limit) or via policies sold by commercial insurance companies on the exchange. The contract for their work as “navigators” is expected to continue through this year’s enrollment period.

But Collinsgru said other funding and resources have disappeared and it is unlikely federal agencies will replenish those coffers; she also said state agencies have done little to promote the ACA exchange. “We expect, based on all the actions this (Trump) administration is taking, that we won’t have the assistance we have had in the past,” she said.

Although questions about Obamacare’s future were already swirling during last year’s enrollment period, early indications suggested there was plenty of interest in the program. Data from the federal Center for Medicare and Medicaid Services, released in late January, showed that some 295,000 people had filed applications to obtain policies through the exchange — 8,000 more than over the previous year’s sign-up period.

(The marketplace also covers about 100,000 residents who do not qualify for subsidies, but aren’t able to access coverage through large employee or other government plans.)

ACA serving NJ well

The NJPP report was designed to demonstrate that, despite Trump’s insistence that Obamacare is failing — by pointing out that several counties in the U.S. have few, if any insurance companies providing policies on the exchange, and prices remain out of reach for many — the system is serving New Jersey well.

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In fact, premium costs in the Garden State showed the slowest growth in the nation between 2013 and 2017, NJPP noted, averaging 3 percent a year — far lower than the double-digit annual hikes in the past. And deductibles here averaged less than $1,600 a year, more than $2,000 less than the national norm. Plus, residents in all 21 counties have several choices when it comes to policies.

“But all this progress could be jeopardized,” warned Ray Castro, NJPP’s healthcare expert, if Congress doesn’t act quickly to ensure funding for the cost-sharing subsidies is in place. This unknown could drive up the cost of marketplace policies by 20 percent, he said, and insurance companies can’t wait until the federal budget is resolved later this year for clarity about this aspect of the law.

Castro said he was “very concerned” about some GOP-led efforts under discussion in Congress that would tie subsidies to regulatory reform, which he suggested would result in less coverage. “They’re trying to hold [subsidies] hostage for their broader ideological goals,” he said.

And while New Jersey has a history of strong regulatory protections for insurance customers — mandates that would survive if the ACA were to be repealed — past experience showed these requirements resulted in policies that were unaffordable for most consumers, Castro noted.

“The ACA came to the rescue by providing subsidies to reduce costs, establishing the individual mandate and providing funding for outreach,” the NJPP report notes. “All those changes made the marketplace much more attractive to healthier individuals, which has helped keep the premium costs down for everyone. Without these components, the marketplace’s success would be threatened.”