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Affordable Care Act Enrollment Kicks Off, Despite Uncertainty

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November 1st marks the start of the open enrollment period for the Affordable Care Act. This is the window where people who purchase their own health insurance can shop for and select a plan for 2018. There is no shortage of confusion concerning ObamaCare, including what’s changed and what hasn’t. NHPR’s Todd Bookman joins All Things Considered Host Peter Biello to discuss open enrollment in New Hampshire.

[The following transcript has been edited lightly for clarity.]

Todd, walk us through the basics:

For starters, Obamacare, also known as the Affordable Care Act, is still very much the law of the land. Healthcare.gov is still up and running, the mandate that individuals must have health insurance or face a financial penalty is still in effect, and insurance companies are here, and they’re competing in New Hampshire. There are still options for consumers.

Not as many options, though, right? Minuteman Health is no longer selling plans.

That is correct. After having four companies selling insurance through the marketplace in the last few years, for 2018, there are three choices: Anthem Blue Cross, Harvard Pilgrim and Ambetter. So, if you have a Minuteman Health plan for 2017, you’ve likely received a letter or email explaining that you’ll need to pick a new option for next year

I should add that most health care experts say it’s smart for everyone to reconsider their options each year because plans do change, and prices certainly change too.

What about those prices? There are some pretty Halloween-esque scary numbers floating around about rate hikes?

Prices are going up dramatically next year in New Hampshire, although not for everyone. After having monthly premiums stay pretty much flat for the first four years of the Affordable Care Act, 2018 will look very different. Rates don’t officially come out until tomorrow, but the Insurance Department says the average rate hike this year is 52%.

But that rate hike is for people who pay the sticker price for health insurance. That is, folks who make relatively more money, and therefore don’t qualify for subsidies. In New Hampshire, that’s about 25,000 residents.

Lower and more moderate income people, however, still qualify for subsidies just like they have in previous years. And because of the way these subsidies work, those customers are actually insulated from the price hikes. That is, they likely won’t pay much more out of pocket than in previous years.

Do we know what’s causing those rate hikes?

I posed that same question to Lucy Hodder. She worked as a health policy advisor for former Governor Maggie Hassan, and is now Director of Health Law and Policy at UNH:

“Part of the reason why they’re going up is that mass confusion in Washington,” said Hodder. “There’s been confusion over whether anybody has to get coverage, whether or not the marketplaces are even going to exist, what kind of changes might happen on the federal policy level. They’ve been extremely volatile, and insurance hates confusion and uncertainty.”

Hodder says the insurance companies are reacting to this uncertainty by increasing their rates.

President Donald Trump and we should say most Republicans during the last seven years have made their opposition to ObamaCare well known. Though the GOP has failed to repeal the law, they have begun to chip away at it, right?

Right. There was President Trump’s move to end what are called Cost-Sharing Reductions. These are payments made to insurance companies. The end result of this cut is an increase in monthly premiums for customers.

A second major change to the law is what kicks off tomorrow: in years past, the open enrollment window lasted three full months. That’s how long people had to shop around and decide what plan they wanted to purchase. This year, the window has been cut in half. The deadline to purchase a policy is December 15th.

The Trump Administration has also scaled back the amount of marketing dollars its spending to remind people of this open enrollment window. So, the end result here could be fewer people buying coverage. That would reverse years of gains, as the uninsured rate has been cut basically in half in New Hampshire since the start of the health law.

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