In a report released Thursday, the Kaiser Family Foundation (KFF) found that President Donald Trump and congressional Republicans' recent actions on healthcare legislation will likely cause double-digit insurance premium hikes for millions of Americans in 2018.
Amid repeated attempts by Republicans to destroy the Affordable Care Act (ACA) under the guise that it's in a "death spiral," and Trump's troubling comments suggesting that his administration may try to sabotage the law that governs the U.S. national healthcare system, insurers are proposing to raise premiums for next year, scale back their offerings, or exit the exchange or individual market all together.
"Since there has not been clarity on these issues, some insurers are already assuming that the Trump Administration or Congress may take an action that would destabilize the market," KFF experts wrote last week.
"In many cases that means insurers are adding double-digit premium increases on top of what they otherwise would have requested," Cynthia Cox, a co-author of the Kaiser report, told the Associated Press. "In many cases, what we are seeing is an additional increase due to the political uncertainty."
And as AP noted, "That doesn't sound like what Trump promised when he assumed the presidency."
Although the ACA, also called Obamacare, applies to the whole U.S. healthcare system—including Medicaid, Medicare, employer-sponsored insurance, and coverage people buy on their own—Republicans' actions are specifically affecting how insurers navigate exchange markets, or marketplaces, which first opened in 2014.
Thus, the premium hikes would have a targeted impact, as the AP reported on Thursday:
About 10 million people who buy policies through HealthCare.gov and state-run markets are potentially affected, as are 5 million to 7 million more who purchase individual policies on their own.
Those in the government-sponsored markets can dodge the hit with the help of tax credits that most of them qualify for to help pay premiums. But off-marketplace customers pay full freight, and they face a second consecutive year of steep increases. Many are self-employed business owners.
For the report released Thursday, KFF researchers examined preliminary premiums and insurer participation in D.C. and the major metropolitan areas of 20 states where filing details were publicly available for proposed costs of the second-lowest cost silver plan—which is "one of the most popular plan choices on the marketplace and is also the benchmark that is used to determine" financial assistance.
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From Albuquerque, New Mexico, to Baltimore, Maryland, multiple insurers have requested double-digit premium increases for 2018, with the highest being a 49 percent average rate hike in Delaware, and only one of the 21 analyzed cities showing an average rate decrease. The average total number of marketplace insurers by state is also expected to decrease, leaving some enrollees with only one or two options for coverage.
Although insurers have until September 27 to finalize contracts or withdraw—"so the data in this report are preliminary and could very well change"—past "requested premiums have been similar, if not equal to, the rates insurers ultimately charge." The report also notes that insurers openly express uneasiness about the uncertainty caused by Trump and Congressional Republicans:
The vast majority of insurers included in this analysis cite uncertainty surrounding the individual mandate and/or cost sharing subsidies as a factor in their 2018 rates filings. Some insurers explicitly factor this uncertainty into their initial premium requests, while other companies say if they do not receive more clarity or if cost-sharing payments stop, they plan to either refile with higher premiums or withdraw from the market.
This new KFF analysis substantiates concerns that have been brewing for several months regarding how Republicans' war on Obamacare will affect marketplace premiums. Shortly after Senate Republicans repeatedly failed to enact new healthcare legislation or repeal the ACA this summer, Trump defaulted to his campaign-era rhetoric with promises that the law would "implode."
The president's candid comments on Twitter last month renewed concerns that he would actively sabotage the ACA, and as Common Dreams previously reported, there are three key ways he could do that: stopping payments on cost-sharing subsidies; reducing or undermining enrollment outreach; and weakening or outright ignoring the individual mandate—which aims to keep costs low by requiring everyone to buy healthcare insurance coverage, or pay a tax penalty.
In May, J. Mario Molina, M.D., former CEO of the insurance company Molina Healthcare, wrote in an op-ed for U.S. News & World Report:
Most of the instability driving up premiums in the marketplace can be directly traced to Republicans' efforts to undermine the health care law for their own political purposes....
The administration and Republicans in Congress want you to believe that insurers raising premiums for their plans or exiting the marketplaces all together are consequences of the design of the Affordable Care Act instead of the direct results of their own actions to sabotage the law. Don't let them fool you.
As Common Dreams reported in the spring, when Trump threatened to stop paying cost-sharing subsidies, critics warned that he was "rattling insurers." KFF's report reflects the likely consequences for Americans because Trump and the GOP did not heed those warnings.