Obamacare sign-ups through Healthcare.gov are down nationally and in Nevada as the final days of open enrollment approach.
Enrollment was about 12 percent lower during week five compared with the same week last year, said Heather Korbulic, executive director of the Silver State Health Insurance Exchange. Korbulic said one of the factors that could be contributing to the decrease is the elimination of the individual mandate, the tax penalty for failing to acquire insurance.
“States on healthcare.gov are seeing decreases in their enrollment from week to week this year compared to last year,” Korbulic said. “Nevada is one of those states.”
The elimination of the individual mandate could mean that fewer healthy people sign up for insurance through the exchange, which Korbulic has said can increase costs. Competing plans may also be having an impact, such as expanded short-term plans that do not cover essential health benefits required under the Affordable Care Act. The Trump administration expanded the length of those plans, which Nevada legally capped at six months.
Aggressive marketing campaigns for short-term and skinny plans have included robocalls and search engine optimization that puts these less-comprehensive options ahead of healthcare.gov and even Nevada Health Link, Korbulic said.
“We are fighting back as hard as we can and being aggressive ourselves in trying to be louder than those people,” Korbulic said. “… A consumer may be thinking they’ve purchased an ACA-qualified plan when in reality they’ve purchased a very skinny plan that doesn’t cover all of the essential health benefits. That could be potentially damaging for them when they find out that their sickness is not covered under their policy.”
Nationally, numbers are expected to increase significantly for these plans, she said, which carries a ripple effect to providers, hospitals and doctors who may not get paid for services that patients need. Korbulic said this could hurt the medical industry’s progress in providing preventive care that reduces the need for more costly emergency care down the road.
ACA subsidies that come into the state as well as job increases in the health care field as a result of more people being insured could also be hurt by growth in short-term, skinny health plans, Korbulic said.
“I worry about the ramifications and the long-term impact of people transitioning into those plans, in the immediate (future) for a consumer and then in the long-term for the economy,” she said.
A possible expansion of the public charge rule, which would add public programs that count against more residents in their immigration process, could also be having what Korbulic called a chilling effect. The proposed rule expansion does not include health care subsidies offered through Obamacare exchanges.
Fewer sign-ups may also be tied to a positive trend, Korbulic said. Lower unemployment could be improving access to health plans.
“The job market in Nevada right now is improving steadily, and that means that consumers are likely accessing insurance through their employers,” Korbulic said.
Nevada’s Medicaid expansion under Obamacare in 2014 was credited for reducing the state’s uninsured population overall as well as among children. The uninsured rate among children went up nationally from 2016 to 2017 for the first time in a decade, according to a Georgetown University report.
Nevada’s uninsured rate for children went up from 7 percent to 8 percent from 2016 to 2017, according to a November 2018 Georgetown University Center for Children and Families report. In 2016, there were 50,000 uninsured Nevada children compared to 58,000 in 2017.
“The nation’s many years of progress in reducing the number of uninsured children came to a halt and reversed course in 2017,” the report said. “Despite an improving economy, national political trends reinforced the notion that publicly funded coverage was at risk.”
The report said Nevada was one of 12 states with uninsured rates for children well above the national average of about 5 percent in 2017, up from 2016’s “historic low” of 4.7 percent. This will likely continue into 2018, researchers say, especially if the Trump administration expands the public charge rule.
“With an improving economy and low unemployment rate, the fact our nation is going backwards on children’s health coverage is very troubling,” said Joan Alker, lead author of the report, executive director of the Georgetown University research center and a research professor at the McCourt School of Public Policy. “This trend is a warning sign to policymakers. Barring new and serious efforts to get back on track, there is every reason to believe the decline in children’s coverage is likely to continue and may get worse for America’s children.”
Korbulic said that while the study shows an increase in uninsured children from 2016 to 2017, Nevada actually saw an increase in its insured population overall from 88,145 enrollees in 2016 to 89,061 in 2017.
Children who became uninsured were typically in the higher end of the federal poverty level, Korbulic said. This could mean that exchange subsidies through advanced premium tax credits need to be higher for those families. This population is not eligible for cost-sharing reductions, and are responsible for more of the cost than individuals at the lower end of the poverty level, she said.
“It could be that people are being priced out even when they are subsidy eligible, or children are,” she said.
Another factor in the uninsured population among children could be the “family glitch,” Korbulic said, which impacts 2-4 million people. Exchange subsidies are blocked to those whose employers offer an affordable plan, Korbulic said. But the cost of adding family members to those employer plans is not considered when determining whether the plan is “affordable,” she said, which would require federal action to fix.
“Since most employers pay a significant portion of their employee health insurance premiums, most employer-sponsored plans are considered affordable,” Korbulic said. “That affordable classification extends to the family members’ coverage as well, even if the employer doesn’t pay any of their premiums at all.”
Korbulic said the exchange is still optimistic that more people will sign up in the final week of the open enrollment period ending Dec. 15. She said enrollment typically surges in the last week.
“We are not really deterred yet,” Korbulic said. “… We’re hoping to limit any kind of total decreases by pushing the pedal to metal over the next several days.”