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Changes for 2018 likely to affect patients’ awareness of open enrollment options

By Chris Harrop
October 30, 2017
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Recent changes to the open enrollment period for 2018 health plans available under the Patient Protection and Affordable Care Act (ACA) have added uncertainty for insurers and confusion for consumers.

That was the assessment of a collection of health policy leaders who sounded off during an Oct. 24 webinar — organized by the Alliance for Health Policy, NIHCM Foundation and the Association of Health Care Journalists — on the topic of ACA marketplace open enrollment.

Karen Pollitz, senior fellow, Kaiser Family Foundation, Washington, D.C., noted that one of the biggest changes to the 2018 open enrollment period is the shortening to six weeks from what had been a 12-week  period, though some state-run marketplaces such as New York and California have extended their periods through the month of January. Paired with a reduction in resources for outreach (federal funding for advertising was reduced 90%) and consumer assistance (federal navigator grants were cut by 41%), the changes at the federal level may complicate the ability for patients to know when and how to search for plans for 2018.

Further muddying the public’s awareness is the ongoing debate over cost-sharing reduction payments to insurance providers on the exchanges. Jeanette Thornton, senior vice president, product, employer and commercial policy, America’s Health Insurance Plans, Washington, D.C., noted that consumers may not be aware of other types of cost-lowering assistance that are still in effect, such as the premium tax credit, after the Trump administration’s move to stop reimbursing insurers for cost-sharing reductions.

Pollitz noted that the ongoing debate on repealing and replacing the ACA has left many consumers unclear about the status of the ACA — about four in 10 uninsured Americans are unaware or unsure whether the individual mandate remains in effect, per the Kaiser Family Foundation Health Tracking Poll from September and October.

Andy Slavitt, senior advisor, Bipartisan Policy Center, Washington, D.C., and former administrator, Centers for Medicare & Medicaid Services, said that recent open enrollment changes have created uncertainty and “a dampening effect,” and expressed concern that some Americans might believe that exchange markets have been eliminated due to declarations from the White House about the demise of ACA markets.

A major component of a patient’s health literacy is understanding insurance coverage, and medical practice staff have a role to play in helping customers better understand coverage and financial responsibility.

The concerns for open enrollment — with at least one major insurer projecting as much as a 70% drop in ACA plan enrollment in 2018 — come as surveys find that the nation’s uninsured rate has risen since the start of 2017, with an estimated 12.3% of Americans uninsured, per the Gallup-Sharecare Well-Being Index, up 1.4 points since the end of 2016.

Additionally, the Department of Health & Human Services’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) issued a research brief Oct. 30 on 2018 plan choice and premiums that the total number of state issuers of exchange plans is down to 132 for plan year 2018, a 21% decline from plan year 2017.

Pollitz noted that the number of insurers offering plans on the ACA exchanges has decreased — from 4.3 plan issuers per state in 2017 to 3.5 per state for 2018 — but that the number of insurers may not always lead to higher consumer costs.

In South Carolina, as Pollitz noted, there is only one issuer statewide for both 2017 and 2018. Though the overall premiums will rise for that issuer’s plans in 2018, the amount paid by subsidy-eligible consumers will be the same or less.

Recognizing those consumers who are eligible for current financial assistance may be a key to further lowering of the uninsured rate. Pollitz said Kaiser Family Foundation estimates about four in 10 of the remaining uninsured in the United States are eligible for some sort of financial assistance, including about 25% of those eligible for Medicaid or other low-income-based assistance in Medicaid expansion states.

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Chris Harrop, senior editorial manager, Publications, MGMA

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