Well, there they go again. Presidential candidates Scott Walker and Marco Rubio have now outlined their plans to replace the ACA, repeating tired myths like the law has increased costs for consumers. While both candidate statements omit critical details, it’s clear that either proposal would be a disaster for consumers. And their rhetoric can deter consumers from exploring the new options for affordable coverage that are available.
Both proposals would repeal a law that has enrolled over two million New Yorkers, lowered costs by an average of 50% in the individual market, set higher standards for health plan quality, and reduced the chances that consumers will be stuck with massive medical bills. According to the Roosevelt Institute’s Richard Kirsch, this would have grave impacts at the national level. The country would “return to the days when insurance companies could deny coverage or charge higher premiums because of a pre-existing condition, charge women more for health insurance than men, and stop paying claims when people have high-cost illnesses.”
Both plans would force millions of people off Medicaid immediately and take away coverage from millions of young people who are on their parents’ plans, according to the Kirsch post. And the Walker plan would allow health insurance to be sold across state lines, threatening a “race to the bottom” in which states compete with each other to attract insurers by loosening consumer protections. New Yorkers could lose the hard-won consumer protections that our State has put in place over many years.
While attacks on the ACA have been less frequent in the past few months, the Walker and Rubio initiatives and continuing proposals in Congress to repeal or cut back the ACA make it clear that the law is not politically out of the woods yet. As New York State begins its third Open Enrollment period, health advocates need to practice how to explain the many benefits of the ACA in New York, and how to debunk the myths that continue to circulate. Thankfully, as the latest Kaiser tracking poll data indicates, the law is now finally supported by a clear majority of Americans, as more and more get covered or know someone who did.
As we discussed in the first blog post of this series, 2.1 million New Yorkers have enrolled in health coverage through the NY State of Health Marketplace (NYSOH) as of the end of the marketplace’s second open enrollment period. NYSOH’s second annual open enrollment report shows one of the key reasons why: the strong program the State has established to provide one-on-one in-person assistance to consumers and small businesses to compare and enroll in health plans.
Two-thirds (67%) of total marketplace enrollees used in-person assistors – Navigators, certified application counselors (CACs) and brokers – in the marketplace’s second year, a significant increase from the first year, when 49% got one-on-one help. All three kinds of in-person assistors are trained and certified by the State. Navigator agencies are funded by NYSOH.
The State’s investment in Navigators and other in-person assistors has really paid off. In the second year, New York made significant progress in enrolling hard-to-reach populations – exactly the New Yorkers that Navigators and CACs are intended to reach. Eighty-nine percent of consumers in the second year didn’t have insurance at the time they enrolled, versus 81% in the first year. Thirteen percent said their preferred language was Spanish, versus 10% in the first year. The state’s Navigators know the communities they serve and are trusted by community members to provide accurate and unbiased information. When you’ve never had health insurance before, or you have limited English proficiency, you’re much more likely to prefer getting help from a community group in your neighborhood than to call a toll-free number. Navigators work evenings and weekends, which is particularly attractive for those with more than one job, irregular work hours, or child care obligations.
The in-person assistance program also expanded in 2015: there were 11,388 trained assistors (Navigators, CACs, and brokers) as of the end of February of 2015, versus 8,960 in 2014, according to the state report. In-person assistance will continue to be a key to the success of NYSOH in 2016, as more and more people hear from their friends, co-workers, relatives and neighbors about the value of assistors in navigating the complexities of health insurance enrollment.
This is the second in a series of blog posts about the NYSOH 2015 Open Enrollment Report.
The New York State Department of Financial Services (DFS) released its final decisions on the rate review process (Don’t remember what that is? Check out our blog post about it here). The 17 carriers on the individual insurance exchange were approved for a weighted average premium increase of 7.1%, which is 3.3% lower than requested by the plans. These figures mask considerable variation among plans; Health Republic, Empire HMO, Emblem HIP, and MVP Health Plan were all approved for double digit rate increases, while United and Oxford OHP had their requests cut by 20.4% and 17.6%, respectively. New York’s individual market has more choices than most other states, so it behooves consumers to shop around to get the best deal for themselves and their families in this upcoming open enrollment period, beginning November 1, 2015.
While the New York State Health Plan Association condemned DFS’s approved rates as too low, their customers can’t help but compare their 7.1% increase to the much lower 4% rate increase California allowed for 2016. As HCFANY described in its rate comments, New York’s proposed and now adopted rate increases exceed the national rate of medical cost inflation predicted by independent analyses; considerably exceed growth in wages, according to the most recent Employment Cost Index released by the Bureau of Labor Statistics; and they are significantly higher than the average rate increase of 5.7% approved by DFS last year.
We recognize that some plans had seriously underpriced premiums in the past and are facing financial difficulties. DFS has a challenging balancing act to perform. DFS correctly notes that its rate reductions will still keep premiums 50% lower than they were before the launch of the New York State of Health marketplace. All told, the prior approval process will save New York consumers $430 million in premiums for 2016. Unfortunately, the price hikes will still hurt.
“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” summarized Chief Justice John Roberts at the end of his landmark June 25th opinion in King v. Burwell. The decision upholds the right of people in states with federally-facilitated exchanges to get “premium tax credits”, the subsidies provided under the 2010 Affordable Care Act to help low and moderate income people afford health coverage.
Narrowly at issue in the case was a clause saying that subsidies are available in exchanges “established by the State”, leading to a legal challenge arguing that people in the 34 states that use healthcare.gov, the federally-facilitated marketplace, should not receive the subsidies. Chief Justice Roberts’s opinion, speaking for a 6-3 majority (Justices Scalia, Alito and Thomas dissented) makes clear that this language was a drafting error and totally contrary to the intent of Congress. Recent media interviews of those involved with drafting the law also support the decision.
In the 1990s, Chief Justice Roberts explained, New York and other states banned insurers from denying coverage or charging higher premiums to anyone due to their bad health. In response, many bought health coverage only when they got sick, forcing health insurers to increase premiums to account for an ever sicker risk pool, causing even more healthy people to drop their insurance (known as the “death spiral”). The ACA addressed this problem by adding two reforms necessary to make the system work: (1) a requirement that all Americans (with limited exceptions) maintain health coverage; and (2) the premium tax credits. In light of this history, Chief Justice Roberts said in his opinion, Congress could not have meant for residents of the 34 states not to get federal subsidies.
As a result of the decision, six million Americans will not be threatened with losing their coverage and health insurance markets are not facing chaos. But it’s also critically important that the ACA has turned a corner. The major legal challenges are over. A majority of Americans now support the law. As ACA supporters, we now have a new opportunity to increase our focus on making the law work rather than refighting the battles of 2009 and 2010.