As uncertainty swirls around the fate of the Affordable Care Act, consumers are likely to face fewer insurance options and higher costs in 2018.
Aetna last week announced that it will stop selling individual insurance plans on and off the ACA insurance exchanges in Nebraska and Delaware in 2018. Coupled with an earlier announcement that it was dropping out of the exchanges in Iowa and Virginia, Aetna will completely withdraw from the ACA marketplace next year.
On top of Aetna's retreat, insurers are starting to ask state regulators to approve large rate increases for 2018 individual policies, in part because they don't yet know if the Trump administration plans to help or hurt the ACA's health insurance exchanges. In the three states that published requested rates last week, insurers sought double-digit hikes, some exceeding 50%.
"There are warning signs here," said Joel Ario, former director of HHS' office of health insurance exchanges and a managing director at consultancy Manatt Health. "We still need some market stabilization. We are still not out of the woods."
Connecticut, Maryland and Virginia have released the rates filed by health insurers for 2018 individual plans. In Connecticut, where there are just two insurers selling individual plans next year, rate increases range from 15% to 34%. Most of Virginia's health insurers asked to hike rates by double digits, with one requesting more than 50% rate increase. In Maryland, rate increases range from 18% to nearly 60%.
The big rate requests in these three states offer a glimpse into what insurers may be planning in the rest of the country. "These states are showing consistently big premium increases, and it does point to the likelihood we'll see that in other states as well," said Larry Levitt, senior vice president of the Kaiser Family Foundation.
Health insurers asked for big rate increases for myriad reasons, but in most cases the question driving a significant portion of the rate hikes is whether key Obamacare-era provisions will remain in play in 2018. Those provisions include the individual mandate penalty that drives people to enroll in coverage and the cost-sharing reduction subsidies that help low-income members afford the coverage.