Obamacare is still not dead: Enrollment for 2019 plans starts this week
As the sixth Affordable Care Act open enrollment period approaches its Nov. 1 kickoff, the long-term prognosis is as cloudy as ever, for reasons bound up in partisan politics and the insurance marketplace.
But the short-term diagnosis is stable. Health insurance coverage will be available for 2019 that complies with all of the mandates enacted under then-President Barack Obama in 2010.
Three insurers are offering plans in Palm Beach, Broward and Miami-Dade counties: Market leader Florida Blue, with a range of plans from budget-priced HMO plans to benefits-packed preferred provider plans (PPO); plus two so-called “narrow network” insurers — Molina Healthcare and Ambetter from Sunshine Health — that offer lower premiums to enrollees willing to live with a smaller selection of doctors.
Known as Obamacare, the ACA has hung in there even though many were preparing to give it up for dead after the 2016 presidential election.
A big reason: Insurers are making money off their Obamacare plans, because federal law still requires the government to heavily subsidize premiums and health-care costs for low-income enrollees.
“In 2017, insurers started rebounding in their financial performance,” said Cynthia Cox, a health insurance policy expert for the nonprofit Kaiser Family Foundation. “But even in the last year or so, we’ve seen insurers on average have become quite profitable in this market. Average growth margins per enrollee have increased sharply, and the share of premiums that insurers are paying out in the form of medical claims is dropping.”
In Florida, roughly 1.72 million people enrolled in an ACA plan for 2018 — nearly as many as the 1.76 million the previous year, despite President Donald Trump’s administration cutting open enrollment from three months to six weeks. Of Florida’s enrollees, 92 percent qualified for subsidies that reduced what would have been a $595 monthly premium to an average of $70.
Costs won’t change much for those enrollees, including about 762,000 from South Florida, in 2019.
Nationwide, the numbers of subsidized enrollees remained stable, increasing from 8.7 million in 2015 to 9.2 million in 2018, according to Kaiser figures.
Those aren’t the enrollees that prompt concerns about the ACA’s long-term health. It’s the enrollees who make too much money to qualify for government subsidies and are forced to pay full price for coverage who proponents worry could destabilize the ACA insurance pool.
They include small business owners and self-employed contractors, such as mortgage brokers, real estate salespeople, accountants, some doctors and nurses, and early retirees with investment incomes. They bore the brunt of steep rate increases imposed by insurers last year under the — correct — expectation that the Trump administration would cut off direct cost shares to insurance companies.