Open enrollment for the individual health insurance market begins today, with consumers purchasing subsidized plans on the healthcare.gov marketplace and unsubsidized plans through insurance brokers or directly from health insurers through Dec. 15.
About 210,000 Oregonians are covered in the individual health market, including about 131,000 on the exchange.
Consumers can anticipate a 5 to 15 percent rise in their healthcare premiums from 2017 to 2018. People who receive subsidized health insurance on the exchange will largely be held harmless for this increase, as their federal subsidies rise to meet the higher premiums.
And despite a recent move by President Donald Trump that ends the federal government subsidies to health insurers for cost-sharing reductions that offset costs to low-income consumers, those consumers will similarly be held harmless.
"Healthcare.gov is still there. Financial help is still available," said Jesse O'Brien, the policy director of the Oregon State Public Interest Research Group. OSPIRG has posted a help sheet for open enrollment on its website.
Insurers will be forced to absorb the cost of the lost subsidies, and the Oregon Department of Consumer & Business Services increased premium rates an additional 7 percent for silver plans.
Middle- and upper-class people who earn too much income to qualify for subsidies will face the brunt of these increases, which have rendered Affordable Care Act health plans increasingly unaffordable for people who have incomes above 400 percent of poverty.
Brown Stumps for Obamacare
Gov. Kate Brown drew attention to the enrollment period on Monday, hoping to keep the state’s insured population hovering around the 95 percent mark or better. Brown’s remarks were intended to end the confusion that has left people wondering if they can or must sign up for 2018 health plans.
“Despite all the noise coming from Washington, D.C., starting November 1st, Oregonians will once again be able to sign up for health insurance with healthcare.gov,” Brown told reporters, while denouncing the “divisive rhetoric” from Republicans who sought to scrap Obamacare without a suitable replacement with a series of bills that would have left 20 million to 25 million Americans uninsured.
Consumers who have an affordable option but choose to go uninsured will still face a penalty come April 15, 2019, as the IRS has insisted it will continue to comply with the individual mandate and ask for verification of health insurance coverage despite comments from Trump suggesting otherwise.
"There's no reason to think you'll be able to avoid that penalty just because the president doesn't like it," O'Brien said. "I would hate for consumers to skip enrollment only to face a big bill from the IRS."
Brown was joined in Portland by Dr. Sharon Meieran, an emergency room physician and Multnomah County commissioner, at Cascade AIDS Project, one of several nonprofit organizations around Oregon that have been hired to help assist people with insurance enrollment.
After Obamacare took effect, Meieran said she saw an influx of new patients into the emergency room, including people who were very sick. Despite the influx, the rate of preventable ER visits has been cut in half since 2011, which she credited to the ACA and state healthcare reforms through coordinated care organizations.
Multnomah County is providing healthcare enrollment assistance at all of its public clinics and sessions at many of the county’s public libraries, with details on its website.
Brown repeated a Democratic talking point that most people who used healthcare.gov received a subsidy -- roughly 77 percent of Oregonians. But that statement is misleading because it leaves out the large number of people who buy individual health insurance off the exchange. In the larger overall market, fewer than half, about 48 percent, received a subsidy.
Law Not Working for Middle Class
Despite the gains from the ACA, Obamacare health plans are bleeding many middle-class Americans, who have to pay as much as 30 percent of their income to get decent coverage.
“You can’t keep putting this burden on the self-employed,” complained Rick Skayhan, an insurance broker at Leonard Adams Insurance in Portland, who primarily helps people who don’t get the Obamacare subsidy deal that keeps insurance affordable.
A 60-year-old married Portland couple with a household income of $70,000 would have to pay almost $21,000 to get an average silver plan in Oregon’s individual health market. Even a catastrophic bronze plan, with a $12,000 deductible, would cost this couple $16,000, or 23 percent of their income.
O'Brien said a growing number of Democrats have called for lowering the age of Medicare to help many, if not all of these consumers, but an easier fix may simply be to lift the artificial income cap on subsidies so that no one has to spend more than 7 to 10 percent of their income on healthcare premiums.
"It's fundamentally not working for that group of people," he said. "It's cold comfort to say you won't have to pay the tax penalty."
Skayhan said he is instructing clients such as independent accountants, real estate agents and health professionals to shift their business model from a sole proprietor to a small business if they can claim any employees or join up with other professionals.
Many upper-middle-class professionals could receive better insurance at a lower price on the group market, even if they have to pay half or all the premium of their employees.
The small group market has community rating so that employers aren’t penalized for having older employees, unlike the individual market, where rates do vary based on age. Small group insurance is also pretax income and comes with a wider network of providers than the plans sold on the exchange.
For consumers who continue to buy on the exchange and in the individual market, Skayhan said people are limited by which plan covers their doctor and preferred hospitals. “It is irrelevant to talk about price,” he said. “You need to talk about doctors and hospitals.”
Skayhan said that if individual market customers want to use the Legacy Health system, they have to choose PacificSource, despite its higher prices. PacificSource premiums average $360 a month compared to $271 a month for Kaiser Permanente and $307 a month for Providence Health Plan.
In the Portland area, Providence Health Plan consumers will be restricted to the Providence network while Moda Health and Regence BlueCross BlueShield will only work in the Tuality, Adventist and Oregon Health & Science University system.
Those restrictions are not true of small group plans, which have a lower risk for insurers.
Reach Chris Gray at [email protected].
