It looks like the nation's health insurers are joining the resistance. With the threat of a Republican White House and Obamacare repeal hanging over them in 2017, many insurers left the Affordable Care Act exchanges. The failure of repeal and the ACA's endurance despite all of Trump's sabotage efforts is bringing them back for 2019.
"This is a complete 180 from where were this time last year," said Cynthia Cox, director for the Kaiser Family Foundation's Program for the Study of Health Reform and Private Insurance. Last July, when insurers were planning for the year ahead, there were 42,000 people in 61 counties who were at risk of having no insurer to cover them. Eventually at least one insurer was found to cover every county, but it took a lot of scrambling from state insurance commissioners. Even so, there were 35 fewer carriers in the exchanges in 2017 than in 2016.
This year, though, insurers are coming back. For example, Molina Healthcare which is looking to go back into Wisconsin and Utah for 2019, after exiting for this year. "We will continue to evaluate our participation on a market-by-market basis," the company says," and are optimistic about the opportunity of offering to more prospective members our high quality, affordable options through the Marketplace." Another insurer, Anthem, is expanding coverage in Kentucky alone to 17 additional counties.
Start-ups like Oscar Health, which already covers large cities including Los Angeles, Nashville, and New York, is going to expand into Florida, Arizona, and Michigan as well as moving into new regions in Ohio, Tennessee and Texas. Asked about whether this means they think the ACA market is stable, Nick Reber, a senior vice president at Oscar, told CNN "We believe it is and will be a great market for insurers."
The insurers that hung in for 2018 proved to the rest of the industry that it still makes sense to participate, and perhaps that it's necessary to do so. They've all dramatically changed their business models and practices to adjust to the changes in the markets made by Obamacare. That was a heavy investment and a new way of doing business that they now want to make work. Even with Trump's sabotage, the insurers who stuck it out figured out how to make it work. "They can price for that," Cox said, of the changes. "They at least know the rules of the game."
This is great news for the majority of customers on the individual market who qualify for subsidies—many will have more choices that are still affordable. It's not, however, necessarily good for those who don't get subsidies, who will face higher premium rates and won't have the cushion of a subsidy to pay for them.
It's also not great news for Republicans running for re-election, whose promises over the past eight years to repeal and replace Obamacare look even more ridiculous. They can't rally their base on over that issue any more. Now own those premium increases that are going to be front page news between now and November, and on top of that, the very real threat from the Trump administration on coverage protections for people with pre-existing conditions. One set of voters will blame for not repealing Obamacare and the other for trying to destroy it.
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