The GOP Failed to Replace the ACA. Can Congress Fix What’s Wrong?
With Republican efforts to repeal Obamacare all but dead for the foreseeable future, attention has returned to the state of the Affordable Care Act, which is in limbo. While Republicans like to say the law is collapsing, the reality is far more complicated. Four years after it began offering coverage, Obamacare provides insurance to about 12 million people through private policies purchased on exchanges. Although the system is working as intended in many parts of the country, some insurance marketplaces are beset by serious problems, with insurers raising premiums or pulling out altogether.
About 80 percent of Obamacare enrollees will have at least two insurers to choose from in 2018, the same proportion as this year, according to a Bloomberg News analysis. There are 38 counties, home to a combined 25,000 customers, where no insurance companies plan to offer coverage on the Obamacare exchanges. These counties are mostly rural, with low population density. For instance, while large swaths of Nevada will be without Obamacare insurers, the areas account for just 9 percent of the state’s Obamacare sign-ups.
President Donald Trump has repeatedly threatened to let the health law fail as a way of building political leverage. “I’m not going to own it,” he said at the White House on July 18, the day after Senate Majority Leader Mitch McConnell was forced to admit he didn’t have the votes to pass his repeal-and-replace bill. “We’ll let Obamacare fail, and then the Democrats are going to come to us.”
Whether that proves to be a correct political calculation remains to be seen. Trump and McConnell are still pressing for a repeal vote, though the odds are against them. The president has the tools to undermine the ACA, including the power to withhold crucial monthly payments to insurers to reduce out-of-pocket costs to low-income customers. His administration has raised doubts about whether it will enforce a tax penalty meant to make people buy insurance, part of the mandate written into the law to bring younger, healthier people into insurance pools to lower costs. It’s also unclear if the Department of Health and Human Services will promote Obamacare when 2018 sign-ups start in November.
While exits by big insurers such as Aetna, Anthem, and Humana are reducing choices in some markets, smaller insurers are swooping in. Centene has said it’s expanding in nine states; Oscar Insurance is growing in five. In Maryland, Cigna won’t be returning to the ACA marketplace next year. But Evergreen Health is reentering the state’s marketplace, so everyone will have at least three companies to pick from.
As Democrats and Republicans in Congress finally begin to talk about potential bipartisan solutions, insurance companies are submitting plans to raise premiums in 2018. BlueCross BlueShield of Tennessee wants a 21 percent hike next year. The company, a primary insurer in the home state of GOP Senator Lamar Alexander, head of a key Senate health committee, says pretty much all that cost hike is the result of uncertainty in Washington. Remove the question marks and the rate hike is near zero, the company says.