Although federal officials said many Americans will pay lower premiums for the most popular Affordable Care Act exchange plans in 2019, an analysis by the Kaiser Family Foundation found insurance premiums would be much lower if not for several Trump administration and congressional actions.
Premiums for ACA silver plans will cost 16% more next year than if Congress hadn't zeroed out the individual mandate penalty and the Trump administration hadn't canceled cost-sharing subsidies for low income individuals or expanded non-ACA plans.
The average benchmark silver plan premium for a 40-year-old will cost $495 per month in 2019, but it would have cost $427 per month if not for those actions, according to the Kaiser Family Foundation analysis published Friday.
Most people buying coverage in the individual market are sheltered from premium increases because they have incomes low enough to qualify for federal subsidies. But the 3.9 million people who do not qualify for subsidies—mostly middle and upper middle-class consumers— will feel the effect of the higher premiums, the Kaiser Family Foundation's Cynthia Cox noted during a briefing with reporters on Friday.
The organization's analysis of hundreds of insurer rate filings found that plans added an average 6% to their rates to account for the zeroed-out mandate penalty and Trump administration rules expanding access to short-term and association health plans, which are loosely regulated and cheaper than ACA plans because they do not comply with the healthcare law's consumer protections.
On top of that, the Congressional Budget Office said the loss of the cost-sharing reduction payments that reduced co-payments and deductibles for low-income consumers drove silver plan premiums up an average 10% in 2018.
"Repealing the mandate penalty and expanding the availability of short-term plans and association health plans effectively siphons healthy people from the ACA marketplaces, driving up premiums as insurers' risk pools include a larger share of sick people relative to healthier ones," the Kaiser Family Foundation explained.
Open enrollment for ACA coverage begins Nov. 1 in most states and lasts for six weeks. Premiums across most of the country are flat or falling for 2019 over 2018. The average benchmark plan premiums in states that use HealthCare.gov will be 1.5% lower next year, the CMS announced last month.
More than a dozen insurers are newly entering or returning to state marketplaces next year, which is a "complete 180" from last year when many insurers fled the market and several counties were at risk of having no ACA insurers, Cox said. That's in part because insurers have started to turn a profit on the exchanges, she said.
