Wednesday, July 26, 2017

Uncertainty about cost-sharing subsidies for ACA policies may leave rural areas short of coverage

The uncertainty over the future of health-insurance laws and regulations is spooking insurance companies, which may cause millions of Americans to lose their federally subsidized insurance. The risk of that is greater in rural areas. Republican senators are still short of votes to repeal or replace the Patient Protection and Affordable Care Act, and with open enrollment for subsidized policies for 2018 only three months away, insurers don't know whether they'll be able to continue relying on federal cost-sharing subsidies to make ACA marketplace plans more affordable.

This uncertainty could hurt rural areas particularly hard, since many already have only one insurer offering subsidized plans, and some have none. "Uncertainty about the future of the subsidies has led some insurers to pull out of the exchanges, saying it’s impossible for them to forecast costs. Others have threatened to drastically hike premiums in order to make up for the lost federal funds," Alex Seitz-Wald reports for NBC News. "Time is of the essence, since many insurers have already begun the months-long process of calculating their estimated premiums for next year, which have to be submitted to regulators for approval well before they hit the market."
Bloomberg News map shows number of Obamacare insurers in each county.
The Trump administration said in April that it would keep funding cost-sharing, but the president recently called them "ransom money," and his appointees could work with Republicans in Congress to eliminate them. Professor of health policy Kenneth Thorpe of Emory University told The Columbus Dispatch that such a move would be "deliberately sabotaging" the markets.

Some states are feeling the pinch. "Just last month, Anthem announced plans to drop out of Ohio’s Obamacare marketplace, a move that would leave more than 10,000 people in 18 counties without access to a federally subsidized insurance plan. Anthem said the 'individual market remains volatile,' saying one reason was 'the lack of certainty' about whether the cost-sharing payments would continue," Jack Torry and Jessica Wehrman report for the Dispatch.

After the Senate's original bill failed, a bipartisan group of 11 governors asked Congress to "fix our unstable insurance markets," reports Seitz-Wald. The governors, along with some insurers, want to secure the federal subsidies and leave the long-term issues for another day.

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