Omaha World Herald: Uncertainty over Affordable Care Act's Future hasn't Slowed Sign-Ups

Jan 8, 2017
In The News

Insurance companies may be backing out of the federal health law, and Republicans in Congress may be moving to repeal it.

But at OneWorld Community Health Centers in South Omaha, staffers tell their clients to sign up for health insurance while they can, and more people in Nebraska, Iowa and 38 other states are taking that advice.

“As long as there’s still plans to choose from and the subsidy is still there, people are still wanting to be covered,” said Andrea Skolkin, OneWorld’s chief executive.

Enrollment on the Affordable Care Act’s exchanges continues to climb in Nebraska, Iowa and across the nation.

More than 85,000 people in Nebraska so far have chosen individual or family health care plans for 2017 through the federal law’s exchange — up 7.3 percent from the same period last year.

The increase in sign-ups reflects the popularity of the law among those who wouldn’t otherwise have coverage, and it underscores the difficult task facing GOP lawmakers and President-elect Donald Trump: How to unravel something that is increasingly entrenched in American life.

Trump promised to replace the Affordable Care Act with something even better. Congressional Republicans have internal differences about how to proceed, with some saying it’s wise to hash out a replacement plan first.

But Iowa and Nebraska Republicans told The World-Herald they are committed to pressing forward with repeal.

“We can’t be wobbly on this,” said Rep. Don Bacon, R-Neb. “I would tell some of my colleagues: ‘If you’re getting wobbly, you needed to be at some of the town halls I had with people screaming at you.’ ”

Despite such vocal opposition to the law, nearly 5,800 more Nebraskans have chosen ACA exchange plans so far in the current sign-up period than by the same point a year ago. Enrollments also are up in Iowa by 5.4 percent to 52,281 people and nationwide by 1.8 percent to 8.8 million, the U.S. Department of Health and Human Services said.

About one-fourth of the enrollees are first-timers.

(Iowa has fewer enrollees than Nebraska largely because its Blue Cross affiliate, Wellmark, did not offer health plans on the ACA exchange. For 2017 it is offering plans in 47 of the state’s 99 counties, not including Pottawattamie County.)

As Barack Obama’s administration comes to an end this month, officials have been making the case for keeping the law.

Secretary of Health and Human Services Sylvia Burwell plans to hold a forum Monday at the National Press Club to explain the benefits of the ACA and consequences of scrapping it.

In particular she plans to lay out problems with a number of alternative approaches that have been floated.

An HHS spokesman said enrollment is up “because this is a product that consumers clearly want and need. It’s affordable, guarantees access to essential health benefits, and consumers can’t be denied access to it due to a pre-existing condition.”

Sen. Joni Ernst, R-Iowa, said the law must be repealed but Congress should be thoughtful. She said there is a lot of misinformation that repeal means Americans could immediately lose coverage, when in fact there will be a transition period.

Rep. Jeff Fortenberry, R-Neb., said he supports repeal but also a fair “stabilizing process.”

Rep. Adrian Smith, R-Neb., said his party is largely unified on the end goal of a better system that ensures affordable, market-based access, but there are different ideas among Republicans about how to get there. “We will need some time for markets to form, but keeping people insured is, I would say, my highest priority,” Smith said.

Rep. Steve King, R-Iowa, suggested that a transition period isn’t necessary. He supports a swift and complete repeal of the law, since existing policies would be in effect through 2017. Among changes he favors: making all premiums tax-deductible and allowing insurance to be sold across state lines.

Bacon’s resolve for repeal is particularly notable because the freshman congressman just won election from a relatively politically balanced district. He said he’s aware that the issue is not completely black and white.

The law has helped some people, and he hears from those on that side of the argument. But even more have been hurt, he said, by rising premiums, high deductibles and the burdens the law places on businesses.

“I’m hearing some folks who are worried that they may lose coverage, and I’ve also got people calling me, (saying) ‘Don, whatever you do, kill Obamacare, it’s killing us.’ ”

The individuals most helped by the law, he said, are those with pre-existing medical conditions, and any replacement plan should include provisions for them. He said there are different ways to do that, such as subsidized high-risk insurance pools at the state or federal level.

Other questions, such as what to do with those who have been receiving subsidized coverage through the exchanges, will have to be worked out, he said.

He and others noted that there will be a transition period of possibly two years during which Republicans will work on those and other proposals that will ensure people have access to coverage they can afford.

“In our country, everybody should have access to affordable care — not free, but affordable,” Bacon said.

The political wrangling isn’t lost on people looking into plans offered by Aetna Health and Medica Health on the ACA’s exchanges, said Emilia Tamayo, who manages OneWorld’s insurance enrollment and financial services office.

“If the politicians don’t know the answers, how should we know?” she said.

OneWorld’s office at the Livestock Exchange Building enrolled 1,592 people, many of them first-timers, on the ACA exchange between Nov. 1 and Dec. 31. For the same period last year, 1,714 people enrolled.

Tamayo said she and the center’s advisers reassure enrollees that they are covered for 2017 and that the law imposes a penalty for not having insurance.

The penalty is an important part of the law because it encourages young, healthy people to buy insurance. Without the threat of a penalty, the insurance pool would be lopsided with the sickest people.

Blue Cross Blue Shield of Nebraska and UnitedHealthCare both stopped selling exchange plans for 2017 because of unexpectedly high claims by people who had the ACA plans in 2014, 2015 and 2016. The two companies sold more than 35,500 health plans on Nebraska’s ACA exchange for 2016, nearly half the state total.

With enrollment open through the end of January, Medica’s enrollments in Nebraska and Iowa are up significantly, exceeding Medica’s expectations, spokesman Greg Bury said. But he said it’s premature to give an exact number of enrollees.

The Affordable Care Act automatically re-enrolls people in their existing plans unless they take steps to quit. When plans are no longer available, such as those dropped by Blue Cross and UnitedHealthCare, the system automatically transfers people to similar plans.

Tamayo, OneWorld’s enrollment manager, said the departure of Blue Cross and UnitedHealthCare doesn’t seem to make a difference to people as long as they can find a policy they can afford.

“They’re looking for the most value for the buck,” she said. Skolkin, OneWorld’s CEO, said clients wonder whether they should bother getting insurance if the law is just going to be repealed.

Even if the ACA is repealed, Skolkin said she believes “there’s going to be some kind of insurance product out there that people are going to be enrolled in. Hopefully the current plans will evolve into that.”

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