Obamacare whiplash leaves states,
insurers with dueling price plans
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[October 20, 2017]
By Caroline Humer
NEW YORK (Reuters) - President Donald
Trump's reversals in the past week on maintaining Obamacare subsidies to
insurers are sowing new confusion over what kind of health insurance
will be available to consumers, and at what price, when enrollment for
2018 begins in two weeks.
Trump said last week his administration would stop paying billions of
dollars in subsidies that help insurers give discounts to low-income
households, one of several moves to dismantle the signature healthcare
law of his Democratic predecessor, Barack Obama.
Since then, Trump has alternately supported, and dismissed, an effort by
Republican and Democratic senators that would reinstate the subsidies
for two years, until a broader replacement to the 2010 Affordable Care
Act, commonly known as Obamacare, can be negotiated.
"We are worried that consumers on (Obamacare) plans will be confused by
all the back and forth and proposed policy changes and that this will
cause them to not seek out assistance,” said Bryna Koch, special
projects coordinator at the Arizona Center for Rural Health, which helps
consumers choose and sign up for individual health plans offered under
Obamacare.

Trump, who promised during his election campaign to repeal and replace
Obamacare, which he has called a "disaster," has said the subsidies
amount to a bailout for insurance companies.
By law, health insurers must still offer the discounts on deductibles,
co-pays and other out-of-pocket costs, even if the government stops
reimbursing them. Insurers say they do not profit from the subsidies.
Anticipating Trump's move, insurers proposed higher prices on monthly
premiums in 2018 to recoup the money. In all but a handful of states,
they submitted two sets of premium rates – a lower rate to use if the
subsidies remained, and a higher rate to use if the funding was cut.
LAST WORD ON SUBSIDIES?
The fate of the subsidies remained in limbo on Thursday. A senior White
House aide said that Trump would demand steps toward repealing Obamacare
in any healthcare legislation, comments that cast doubt on the prospects
for the bipartisan effort to shore up insurance markets.
A California court is expected to consider on Monday a request by
Democratic attorneys general to keep the subsidies flowing until a legal
challenge to Trump's decision is resolved.
If the funding is not restored when 2018 enrollment opens on Nov. 1,
many consumers will see premium rates that are on average 20 percent
higher than they would have been otherwise.
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A man looks over the Affordable Care Act (commonly known as
Obamacare) signup page on the HealthCare.gov website in New York in
this October 2, 2013 photo illustration. REUTERS/Mike Segar/File
Photo

Even before Trump's decision on the subsidies, the Congressional
Budget Office said the Republican president's policies to roll back
Obamacare enrollment efforts would lead to 4 million fewer people
signing up for insurance in 2018 than previously forecast. The CBO
still expects 11 million people to sign up for next year - an
increase from this year's enrollment of 10 million.
The federal government has already halted a subsidy payment to the
insurance industry for October. But leading insurers are not yet
sure whether that is the last word.
Anthem Inc Chief Executive Officer Joseph Swedish told Reuters he
could not yet predict how ending the subsidies or restating them
through "potential congressional action" would affect pricing next
year. Anthem has submitted premium rates that account for the
subsidies being cut.
Should the subsidies be restored at any time after Nov. 1, insurers
may be able to revert to the lower monthly premium rates, or provide
rebates for consumers.
"A midyear change in premiums would be highly unusual, but this
would be the right thing to do," said Marc Harrison, CEO of
Intermountain Healthcare, a Utah-based health plan and hospital
chain. "Intermountain Healthcare would pursue this."
Washington state's insurance regulator said it would allow insurers
to change rates as soon as practical - even the next month - if
lawmakers reinstate the funding, an approach backed by the National
Association of Insurance Commissioners. But that could run up
against federal government objections.

The Affordable Care Act does not allow for changes to premium rates
after they have been finalized, an official for the U.S. Department
of Health and Human Services said. At the same time, the
administration is working to approve higher rates in several states
that did not take into account Trump's cut in subsidies for 2018.
(Additional reporting by Yasmeen Abutaleb in Washington; Editing by
Michele Gershberg and Peter Cooney)
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