Fewer health insurers and higher rates are expected on the federal marketplace, where more than 150,000 蜜聊直播ns bought plans last year.
Last year, five insurance companies sold 31,161 marketplace plans to Pima County residents. Open enrollment begins Nov. 1 for coverage in 2017.
So far this year, the number of insurers expected to sell to Pima County on the marketplace is two 鈥 Health Net of 蜜聊直播 and Blue Cross Blue Shield of 蜜聊直播.
And there has not yet been a commitment from any company to sell marketplace plans in Pinal County, where 9,600 consumers bought Affordable Care Act marketplace plans last enrollment season.
$75 premiums
A says consumers who purchase insurance on the marketplace, created through the Affordable Care Act, shouldn鈥檛 worry.
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The important thing for consumers to know is that if rates go up, federal subsidies to help consumers pay for their insurance will also go up, federal officials say. Even if all insurers hike their rates by 50 percent, 68 percent of 蜜聊直播ns would still be able to purchase coverage for less than $75 per month, the report says.
All marketplace premiums will be finalized and public in October. Enrollment is set to begin Nov. 1.
Some insurers have said they are pulling out of the marketplace, including insurance giant Aetna, that it would be pulling out of selling marketplace plans in 蜜聊直播 and several other states, too.
鈥淭he simple story is, it ain鈥檛 over until it鈥檚 over. It appears there are discussions going on regarding Pinal,鈥 said Allen Gjersvig, director navigator and enrollment services for the 蜜聊直播 Alliance for Community Health Centers.
鈥淲e are not panicking. ... People do want answers, but sometimes you have to wait until the process runs its course.鈥
Election games
Most Americans don鈥檛 get their health insurance via the marketplace, often also referred to as the exchange. If you are on Medicaid, Medicare (or any government insurance) or have employer-sponsored insurance, you don鈥檛 need to use the exchange.
Some people refer to the marketplace as 鈥淥bamacare insurance.鈥 It鈥檚 where working-age individuals and families purchase commercial insurance and, depending on their income, can qualify for federal subsidies to help pay for it.
While some states have created their own marketplaces, often called exchanges, 蜜聊直播ns use the federal marketplace. The website is H. Nearly 180,000 蜜聊直播ns are currently covered by marketplace plans.
Most 蜜聊直播ns who bought insurance through the insurance exchange last year qualified for federal subsidies to help them pay for it.
Officials from said last week that they have been part of many conversations with the federal government since learning that Pinal County would have no marketplace plans. The company is currently re-evaluating its 2017 plans, spokeswoman Anne Christensen wrote in an email.
With fewer choices, the market doesn鈥檛 work as well and premiums go up, says health-policy expert Dr. Dan Derksen of the
Yet Derksen remains optimistic about Pinal County, and about the marketplace for 蜜聊直播ns.
He says the people most vulnerable to rate hikes 鈥 those earning 250 percent of the federal poverty level or less 鈥 won鈥檛 see big jumps in their premiums due to subsidies and cost-sharing.
This year is an unusual one, he added. Next year the marketplace could be looking more like it did in 2015.
鈥淭he fourth open-enrollment period starts this Nov. 1. Another big event happens Nov. 8. I don鈥檛 think it鈥檚 a spurious correlation that large insurers are exiting right before the national election,鈥 he said.
鈥淚n chess they call it a gambit. ... The market stuff is a little brutal, but this is more than just a bit coincidental.鈥
But it鈥檚 a risky gambit, Derksen says, as it鈥檚 late in the game to temporarily sacrifice market share in the hopes of getting a market monopoly, weakening federal regulations and/or increasing profits.
鈥淐onsumers and voters will remember, as will the next president,鈥 he said.
Public option
The enthusiasm around former Democratic presidential candidate Bernie Sanders and his support of a Medicare-for-all for health insurance is not going to be forgotten under a new administration, Derksen said.
If there are no choices, then some kind of public option needs to be one of those so populations don鈥檛 go without coverage, he said.
鈥淪hould insurers continue displacing hundreds of thousands of Americans by jumping in and out of the ACA (Affordable Care Act) marketplace, public pressure will undoubtedly mount to create a public option,鈥 Derksen said.
鈥淟arge swaths of rural and urban areas, and as the evidence shows, minority populations, are the populations left without reliable insurers or qualified health plans.鈥
During the second year of open enrollment 鈥 2014 to 2015 鈥 10 insurers were offering more than 100 plans in Mariciopa and Pima counties, Derksen said.
鈥淭he consumer will still have choices, but there will be a difference in our market. There will be a lot fewer plans, but it will be a lot simpler,鈥 he said. 鈥淲hen it was a huge number it was a bewildering array.鈥
Finding a doctor
Tucson insurance broker Ray Magnuson, owner of Magnuson & Associates, is hearing everything from anger to panic from clients who are getting letters from insurers like United and Humana saying their marketplace plans will not be offered in 2017.
Magnuson says panicking is not helpful and like others stresses that the rates and plans available won鈥檛 be final until Nov. 1. And there still could be a third insurer offering plans to Pima County.
But he also understands consumer frustration. For one thing, constantly changing plans means consumers are often having to switch doctors. Magnuson hears from people who have a lot of trouble finding new primary-care physicians in Tucson.
And based on the information available right now, Magnuson says it looks like the only kinds of plans available on the Pima County marketplace for 2017 will be HMOs, which can mean a narrow network and a primary-care physician referral needed to see a specialist.
Also, Magnuson is worried that some 蜜聊直播ns trying to buy marketplace plans are going to face big premium hikes, particularly if they don鈥檛 qualify for a subsidy. He says clients in the 2015-16 enrollment season were 鈥渞egrettably satisfied,鈥 meaning they weren鈥檛 thrilled with the prices of marketplace plans but it was better than not having insurance, he said.
But if prices go up double digit percentages, some consumers may opt to pay a penalty for not having insurance and decide to go without, he said.
And then there's a risk of what some call a "death spiral" for the marketplace.
"The risk is that folks will be scared out of the exchange and they won't buy and then we'll have more people uninsured again," said Phoenix-based healthcare expert Jim Hammond, who is CEO and publisher of The Hertel Report, a health newsletter.
"The people left in the insurance pool will be more low income and people who really need insurance...This is kind of a death spiral for the health insurance marketplace. You essentially scare out the healthy."
If insurers are only covering sick people, then they are going to have trouble making money, which is why they are leaving in the first place, Hammond said.
"If you make $85,000 per year and you have two kids and your insurance goes up by $70 per month, you might not buy it," he said.
Subsidy protection
Federal subsidies for marketplace plans are offered to individuals and families who earn up to 400 percent of the federal poverty level ($47,520 per year for a single person, $97,200 per year for a family of four) Those subsidies act as a protection to consumers to keep coverage affordable, Gjersvig said.
If premiums go up, then more people will receive greater amounts of tax credits in 蜜聊直播 than in previous years, he said.
In the first year of the marketplace, 蜜聊直播 premiums were some of the lowest in the country and as a result, tax credits here were also lower. This year, they are likely going to be higher, Gjersvig said.
鈥淚t is not yet final and there is a very good probability that one organization or two will offer plans in Pinal County. And the coverage that people have now stays in place until Dec. 31, as long as you pay your premiums,鈥 he said.
鈥淲e鈥檙e watching very carefully to make sure that 蜜聊直播 consumers using the marketplace understand their options.鈥
Gjersvig said some families will also have a new option for covering their children this year 鈥 KidsCare, which is a government insurance program for children in families that earn too much to qualify for Medicaid, but not enough to affordably pay for commercial health insurance.
Monthly premiums for KidsCare start at about $10 and go up to approximately $70 per month based on income and family size. Enrollment in the program was frozen in 2010 but reactivated this year, and about 30,000 蜜聊直播 children are expected to enroll by the end of the year.
Grim news
While there have been grim headlines about insurers pulling out of the marketplace and massive rate hikes, that does not always reflect what consumers pay, federal officials told reporters on Wednesday,
Last year, the average 蜜聊直播 premium increased $4 per month for consumers with tax credits, and 7 out of 10 marketplace consumers could purchase 2016 coverage for less than $75 per month, the federal report says.
And the U.S. Department of Health and Human Services is stressing that before the Affordable Care Act, many Americans were barred from coverage because of pre-existing conditions.
Also, those who did have insurance through the individual market were often trapped in a plan, since people with even small health problems could be denied coverage or charged an exorbitant price if they tried to switch plans.
The federal report also says that independent researchers recently calculated that 2016 marketplace rates are anywhere between 12 and 20 percent below what the Congressional Budget Office initially predicted.
At the same time, the administration is working to develop 鈥渘ew, innovative ways of paying for care that align payment with improved outcomes and can help sustain and build on the slowdown in health care costs,鈥 a federal news release says.
The nonprofit Commonwealth Fund released Wednesday that says robust enrollment is critical to keeping marketplace prices competitive. The report suggests federal action to keep prices competitive, including extending a reinsurance program funded through insurer fees. Another suggestion is having a public option.
The Commonwealth Fund estimates about 24 million Americans remain uninsured and that about half of them are potentially eligible for subsidized marketplace insurance.
"I am hopeful that the health plans will be able to get through this phase, but I think the law needs some tweaking," Hammond said.
