More Certainty Leads to More Health Insurers in 2019 Obamacare Exchanges

Health insurers don’t like a lot of the Trump administration’s actions, but now that they know for certain what will happen, they’re boosting their presence on Obamacare exchanges for 2019.

That’s the take of health insurance actuary David Shea in a recent telephone briefing held by the American Academy of Actuaries that I covered.

“Carriers now feel comfortable,” knowing that cost-sharing reductions for low-income people are not going to be directly reimbursed by the federal government, Shea said. President Donald Trump discontinued the payments in October 2017 because Congress has not appropriated funding for them.

After several years of speculation about whether the Trump administration would enforce the Affordable Care Act’s individual mandate penalty for not having qualified coverage, the matter was settled when Congress repealed the penalty in 2017.

Health insurers opposed both of those measures. They are required under the ACA to provide the cost-sharing reduction subsidies. They have also religiously argued that some method is needed to push healthy people to buy health insurance, or the individual market will be top-heavy with sicker people who have higher claims.

But now that they know how those issues are playing out, it gives them the certainty they need to price plans for the exchanges, Shea said. “Carriers are feeling a little bit more on solid ground, and I also believe that their ACA experience has started to improve somewhat,” which is leading to increased carrier participation for 2019, he said.

The American Academy of Actuaries recently released a report on 2019 premium changes, listing policy changes as well as the underlying growth in health-care costs as primary drivers.

Washington, D.C.-based health care policy consulting firm Avalere Health also released an analysis finding that early insurer filings in 10 states and the District of Columbia show 15 percent average premium increase requests compared to 2018.

If the rates are approved, that will be the third year in a row of double-digit premium increases.

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