Big changes are almost certain for the Affordable Care Act following the election of Donald Trump, as Republicans will soon control Congress and the White House.
But insurers, advocates, politicians and the U.S. Department of Health and Human Services all seem to agree that 2017 policies — and their premium subsidies — will be honored.
“Consumers who purchase 2017 coverage are signing a contract with a private insurer,” said Jonathan Gold, spokesman for HHS. “Health insurers have also said that consumers who select a plan and pay their first premium will have coverage for 2017.”
Texans continue to sign up on the ACA marketplace for 2017 coverage. Open enrollment continues until Jan. 31, but those who want coverage starting in January must purchase a plan by Dec. 15.
Stacey Pogue, senior policy analyst for the Center for Public Policy Priorities in Austin, said any changes to the so-called Obamacare law will be implemented in later years.
“The marketplace for 2017 is locked in despite what Congress does,” she said. “It’s changes in the future they will be voting on, not immediate changes.”
Even most politicians have gone on record to say ACA changes won’t be coming quickly for policyholders.
Speaker of the House Paul Ryan told the Milwaukee Journal Sentinel this week that there will be a repeal vote early next year, but suggested that it will not be replaced even by next fall.
“Clearly there will be a transition and a bridge so that no one is left out in the cold, so that no one is worse off,” he told the newspaper. “The purpose here is to bring relief to people who are suffering from Obamacare so that they can get something better.”
In the first four weeks of open enrollment, 220,379 Texans signed up for coverage, down less than 2 percent from the same period last year, according to HHS. This is before automatic re-enrollment occurs in mid-December, however, which could explain the slight decrease, said Gold.
“We’re about on track with last year,” Gold said. “So far, more than two million have signed up nationally, which is ahead of last year.”
In 2016, 1.3 million Texans signed up for health insurance on the marketplace, with the vast majority — more than 913,000 — receiving almost $3 billion in premium tax credits, according to the Kaiser Family Foundation. Texas ranked No. 3 behind California and Florida in premium tax credits coming into the state. Nationwide, $32.8 billion in tax credits were received by 9.3 million enrollees.
This year, HHS has calculated that almost two million more Texans and 12 million nationwide could qualify for premium subsidies for 2017 than before. In Texas, that group includes:
▪ Current unsubsidized marketplace customers: 38,600 Texas consumers, or 20 percent of the current unsubsidized Texas marketplace who didn’t get tax credits last year, could be eligible for tax credits in 2017. This is because financial assistance, while based on household size and income, increases with rate increases, which were substantial this year.
▪ Off-market consumers: Around 252,000 Texans pay full price for individual coverage in off-marketplace plans. But based on their income, they would be eligible for tax credits if they bought their policy on the marketplace. Off-market plans do not qualify for tax subsidies.
▪ Uninsured consumers: About 1,629,000 uninsured Texans have incomes indicating they could be eligible for financial assistance. Nationally, 84 percent of marketplace-eligible uninsured Americans have incomes suggesting they are eligible for tax credits.
While premiums went up 18 percent on average in Texas for 2017 for the benchmark plan [the Silver plan], Texas plans saw increases as high as 48 percent. Tax subsidies will rise along with premiums, however, HHS said.
For example, in 2017, a 27-year old in Texas making $25,000 per year will pay $142 per month to purchase the benchmark plan, about the same out-of-pocket cost as in 2016, HHS said. The cost is the same because on average that person would receive a $119 tax credit — 53 percent more than in 2016.
The marketplace in Tarrant County has shrunk considerably for 2017. Last year, the marketplace had 63 plans and six insurers; this year it is offering 26 plans from two insurers, AmBetter and Blue Cross Blue Shield of Texas.
Those who were with an insurer that’s leaving the marketplace will automatically be reassigned a similar plan with one of the two remaining insurers, Gold said, unless they shop for a new plan on healthcare.gov or through a navigator or agent.
This week, Blue Cross Blue Shield of Texas, the only insurer in every county in Texas, came out with a statement to assure their policyholders.
“We recognize our customers may have questions about how the latest election results could impact their health care benefits. For now, nothing changes,” the statement said. “While there are questions around the future of the ACA and what that looks like, it’s clear that changes are needed in the industry to improve quality, drive down health costs and support stable markets “
AmBetter could not be reached for comment.
Remember, IRS penalties for not being insured reached their highest level this year. The penalty for being uninsured is 2.5 percent of total household adjusted gross income, or $695 per adult, and $347.50 per child, whichever is greater, for a maximum penalty of $2,085. The flat fee will be adjusted for inflation starting in 2017.
Teresa McUsic’s column appears Saturdays. TMcUsic@SavvyConsumer.net
- Navigators. To find a navigator to help with the sign-up process, go to the search tool by zip code at www.GetCoveredAmerica.org.
- Hotline and online. Call the federal toll-free call center is 800-318-2596 or go online at www.healthcare.gov or for Spanish-only, www.cuidadodesalud.gov.
- Agents. For a directory of local independent insurance agents, go to the Texas Association of Health Underwriter’s website at www.tahu.org.