Health Plan Payment and Reimbursement

Sept 30-Oct. 5: ACA Premiums to Decline for First Time

September 28, 2018 8:59 am

Premiums may further decline in states that have bolstered their marketplaces using waivers, the HHS secretary said.

Sept. 27—Final premium rates for the Affordable Care Act (ACA) marketplaces are expected to keep rolling in next week, even as the Trump administration is anticipating a historic first.

Premiums for the benchmark plans on the 38 states with federally operated individual-insurance marketplaces will decline by an average of 2 percent, according to projections by the U.S. Department of Health and Human Services (HHS). That compared to a 37 percent increase in average monthly premiums for benchmark plans in the 2018 federal exchanges, a 25 percent increase for 2017 plans, 7.2 percent for 2016 plans and 2 percent for 2015 plans.

During an address Sept. 27 to the Nashville Health Council, Alex Azar, secretary of HHS, revealed the first-time decline in any average rate for plans sold in the marketplaces created by the ACA. Additionally,the number of insurers selling plans on the federally operated exchanges was expected to increase for the first time since 2015.

“Under President Trump, premiums are dropping and choices are returning,” Azar said. “Here in Tennessee, the proposed benchmark rate will drop by 26 percent—more than a quarter.”

The decline belied widespread criticism of administration actions that were expected to drive up premiums, such as the approval of alternatives to ACA coverage and support for legislation that will eliminate the penalty for the individual mandate starting in 2019.

The improved outlook for the ACA marketplaces also was seen by insurers.

“For 2019 open enrollment period, consumers will generally have more choices than in years past and every county will have at least one option for individual market coverage,” said Cathryn Donaldson, director of communications for America’s Insurance Plans. “And, yes, premium increases are generally lower, and, in some markets, premiums have decreased as insurance providers enter new markets.”

Critics of the administration shrugged off the unprecedented decline in premiums, which have doubled since the marketplaces began operating in 2014.

“ACA premiums are stable for 2019 because they went up so much this year due to an uncertain environment and regulatory actions by the Trump administration,” said Larry Levitt, senior vice president at the left-leaning Kaiser Family Foundation. “Premiums would be going down a lot if not for repeal of the individual mandate penalty and expansion of short-term plans.”

Other Steps

Azar said he expected premiums to continue declining in states that use waivers to bolster their marketplaces.

For instance, rates in the Maryland marketplace had been projected to rise significantly, but following the administration’s approval of a reinsurance program last week, Maryland’s insurance commissioner announced that rates will decline by an average of 13 percent.

But Azar indicated that the marketplace affordability problems are expected to return.

“The ACA is not ‘fixed’ or even ‘fixable’ without Congress’s repealing and replacing it,” Azar said.

Instead, he touted alternatives to ACA coverage that have been approved by the administration, such as short-term, limited-duration insurance. The administration earlier this year rolled back Obama-era restrictions, allowing such plans to again last up to one year and allowing consumers to keep that coverage for up to 36 months.

“These plans are dramatically more affordable than the plans regulated by the ACA, often 50 to 80 percent cheaper,” Azar said.

The administration expanded access to association health plans, which allow small businesses and the self-employed to band together to negotiate lower rates.

Azar also touted the repeal of the ACA’s individual-mandate tax, three-quarters of which was paid in 2016 by households earning less than $50,000 a year.

“The defenders of the Affordable Care Act said that undoing the tax would ‘gut’ the exchanges and ‘destroy’ the law, claiming it was a ‘life or death issue’ for American families,” Azar said. “In the same vein, they said expanding affordable short-term options would make rates ‘skyrocket.’ These architects of the ACA could not have been more wrong.”

Sunday, Sept. 30

Medical Group Management Association’s Annual Conference, Boston (through Oct. 3). Learn more.

Inovalon Client Congress 2018, Washington, D.C. (through Oct. 2). Learn more.

Monday, Oct. 1

Hospitals selected to participate in Bundled Payments for Care Improvement Advanced. Learn more.

Frost & Sullivan’s Growth, Innovation and Leadership 2018 North America Summit, San Diego (through Oct. 4). Learn more.

ACEP18-Scientific Assembly, the annual meeting of the American College of Emergency Physicians, San Diego (through Oct. 4). Learn more.

Tuesday, Oct. 2

Webinar by America’s Health Insurance Plans (AHIP) titled “Improving Administration with Intelligent Automation.” Learn more.

Web conference by the Advisory Board titled “How to Attract and Retain Breast Cancer Patients.” Learn more.

Sixth Annual Coupon and Copay meeting, Philadelphia (through Oct. 3). Learn more.

Wednesday, Oct. 3

Hearing by the Senate Subcommittee on Children and Families titled “Rare Diseases: Expediting Treatments for Patients.” Learn more.

Conference call by CMS titled “Final Modifications to the Quality of Patient Care Star Rating Algorithm.” Learn more.

Webcast by the Agency for Healthcare Research and Quality titled “Implementing the New CAHPS® Protocol for Obtaining Patient Comments About Their Care.” Learn more.

Webinar by AHIP titled “Consumer Experience Technology: Boost Engagement and Lower Costs.” Learn more.

National Association of Accountable Care Organizations Fall 2018 Conference, Washington, D.C. (through Oct. 5). Learn more.

Webinar by AHA Physician Alliance titled “The Cleveland Clinic Way: Transforming Health Care throughout its Enterprise and Across the World.” Learn more.

Deadline for recommendations for participants in the HHS Deputy Secretary’s Innovation and Investment Summit. Learn more.

Webinar by The Joint Commission titled “2018 Hospital CMS Update.” Learn more.

Deadline for the submission of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient perspectives on care survey data for second-quarter 2018 (April 1–June 30, 2018) discharges. Learn more.

The 2018 Public Health Law Conference, Phoenix (through Oct. 6). Learn more.

National Affordability Summit by the Network for Regional Healthcare Improvement, Washington, D.C. (through Oct. 4). Learn more.

Thursday, Oct. 4

Webinar by Oliver Wyman titled “Personalized Squared: Bridging the Gap Between Personalized Medicine and Personalized Wellbeing.” Learn more.

Private Equity Investing In Behavioral Healthcare Companies meeting, New York City. Learn more.

Webinar by AHIP titled “How Digital Engagement Helps Members Manage Health Finances.” Learn more.

Public meeting of the Medicare Payment Advisory Commission, Washington, D.C. (through Oct. 5). Learn more.

Friday, Oct. 5

Deadline by CMS for hospice provider reviews of the Hospice Item Set and CAHPS reports. Learn more.

Provider Compliance Focus Group Meeting by CMS. Learn more.

Live event by the Alliance for Health Policy titled “Improving Care for Children with Complex Medical Need,” Washington, D.C. Learn more.

American Heart Congress—CVD meeting, Los Angeles (through Oct. 6). Learn more.


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