Many people who support the federal care act were relieved when Republicans failed to repeal the measure. No one has said that is the end of the troubles for Obamacare. Uncertainty about the future of the program is causing insurers to raise rates and pull out of health exchanges. Yesterday, California announced a premium boozed up 12.5% and anthem Blue Cross will pull out of Southern California, affecting more than 4000 San Diego's. We have Anita Todd who is the senior president with health center partners of Southern California. Welcome to the program.My pleasure.Republicans benefit saying that the ball of -- Obamacare exchanges are imploding. We see we have doubled digit premium increases for two years in a row. Is it imploding ?I think imploding is not the correct word to use. If you want to look back to pre-ACA, we saw double-digit increases were quite the norm. Over the last seven years, we have seen stabilization. Even though the prices have gone up, they have not gone up as much as they were regularly going up before the Affordable Care Act. That does not help family who sees the cost go up but we see the ACA has constrained the increases although we are seen increases due to the uncertainty about the Affordable Care Act and the cost sharing reductions.How do the increases that we see in California, how do they compare to what the rest of the country you see ?They are pretty low for California. California has the largest exchange in the country as well as the large it largest market. California has been committed to the affordable care act and a worked hard to define benefits and create the best environment for the plan to be successful. While there are some communities, world communities in California that are concerned with the lack of insurers, most of the Californians have two or three plans to choose from within the regions -- their regions. It is a mixed bag. It is not doing everything that we hoped and prayed for with the ACA but for many people, 80% of the people in California, they are doing well.How much of the increase is from the cost of care going up versus insurance companies trying to hedge bets against the uncertainty of the market ?I am not sure. One thing we did know would go into effect was the health insurance tax. That is a one time adjustment that would happen. It is 3% cost that is on the premium increase. What California has said, it is not just the fact that they have a riskier population. We have done well in that regard. It is the cost of care going up and the utilization of services. If people did not have insurance forever, when they get it, they utilize it. That will normalize over time as people get medical needs paid attention to. Initially, with the rush for people to get insurance, we do see overutilization in the first three years.There is the possibility of the state 12% increase on the silver to your plan. It is called a surcharge. Actually, it is hard to know how much the increases the consumer has to pay because there is an extremely complicated system of subsidies and credits that the state is trying to juggle.If I can make it as simple as possible, we talked about there being two ways for low income families to get help through the Affordable Care Act. The first was the expansion of Medicaid's for families. Families make more the net, there was additional things put in place like cost sharing reductions. As we get more detailed about it, there was a bronze planned add a silver plan and so on and so forth. What they were aimed at was allowing working families and I mean a family of four making 60 $500,000 to get extra help on premiums and co-pays and deductions if they purchase a silver plan. The bronze plan is the bare-bones and high deductible plans and silver was more comprehensive. In order to encourage people to get the coverage they needed, the additional payments were put in play to help families get comprehensive care. The cost sharing reduction, the administration is paying them by month. Those were two avenues for people to get better care. We recognized it was the cost of care that was prohibiting people from getting insurance.What you are saying, they were paid back by the government for the discounts to consumers. Now, they are only getting paid back month by month and therefore, this is making the insurance leery about what premiums they will be asking for for a year next year.Absolutely. The first concern is that individual mandates. Less people are mandated to be in a market. Secondly, it was the assistance to help families pay for the premiums. That is being held hostage month-to-month. The Trump administration has paid the since they came into office but each month, there is a threat that they will not be paid and recognizing that insurers raise rates for 2018 based on the summer of 2017. With the uncertainty about repeal and whether they will make the payments come they are going to build in something to ensure the sustainability of their organizations.Anthem Blue Cross is pulling out of insurance markets, forcing more than 150,000 people to find new plans and that includes 4300 people right here in San Diego. What is the rationale behind that ?I believe they each have various reasons for doing it. There are some health plans that make tons of money. There are others that have gotten a larger share of sicker patients in rural areas. There are 19 regions in California. Blue Cross should chose to stay in three regions. The other will be forced to look for a different insurer. It would be concerning to me if you see them pull out of every market. This is happening, especially with that particular insurer across the country.What is the likelihood of another repeal effort this year?Well, I am hopeful that we can rest a little bit from repeal. I do know that was a central concern, particularly because as the government wants to pivot towards tax returns, there needs to be some pay forward and the Medicaid cuts were designed to help tax reform. I think we were successful in stopping the initial repeal, there will be additional opportunities for the Congress to relook at this and certainly, they have the opportunity to do reconciliation which is a simple vote through the end of the fiscal year which is September 30.I have been speaking with the senior vice president for external affairs with health center partners of Southern California. Thank you.It is my pleasure.
Monthly premiums for California health insurance plans sold under the Affordable Care Act will rise by an average of 12.5 percent next year, the second consecutive year of double-digit rate increases, officials said Tuesday.
A major insurance company will stop offering plans in most of California, but the state will avoid the massive market upheaval that has left some states with just one insurer or none at all to serve the individual market.
Covered California's announcement on 2018 pricing comes at a time of extreme uncertainty about the future of the U.S. health care system. A Republican plan to unwind key pieces of the Affordable Care Act failed in the U.S. Senate last week, but President Donald Trump has repeatedly urged lawmakers to keep working on it. Trump has threatened to end payments that insurance companies receive to keep down out-of-pocket costs for lower-income consumers.
RELATED: What’s Next In The Health Care Debate?
Premiums for consumers on silver tier plans, the most popular, could spike even more if those subsidies are taken away, officials said.
The average 12.5 percent increase is down just slightly from last year, when premiums rose by more than 13 percent. Consumers could lower their increase to about 3 percent if they switch to the lowest-priced plans, officials said, though that could require them to change doctors. Insurance plans for next year will be available for purchase in California between Nov. 1 and Jan 31.
Covered California sells health plans to about 1.4 million people who don't get coverage from an employer or from the two large government-funded programs, Medicare and Medi-Cal. The exchange is a central piece of Obama's health insurance overhaul, allowing people to compare policies and collect a subsidy if they qualify based on income.
Covered California customers who get federal tax credits to lower their monthly premiums will be shielded from all or part of the higher costs because their subsidies will rise in tandem. But the higher prices will be felt by the more than 1 million Californians who have unsubsidized coverage in the individual market, most of whom don't get their plans through Covered California.
Trump maintains that Obama's health law is imploding and must be fixed, pointing to rising costs and declining choices in the individual insurance market. A handful of rural counties around the nation have been left without any insurers offering plans through Affordable Care Act marketplaces, and many others have just one option.
RELATED: Coalition Of San Diego Health Care Groups Protests Efforts To Replace Obamacare
Peter Lee, executive director of Covered California, said the state shows that insurance markets are not failing. "We in California ... are not just stable, but stable in a way that is truly working for consumers," Lee said.
California has seen costs rise, but it has maintained a competitive marketplace with several competing options for most consumers statewide. All 11 existing insurers will continue to provide coverage next year, but Anthem Blue Cross is significantly reducing its coverage.
The company will continue offering plans only in Santa Clara County and rural parts of Northern California and the Central Valley, forcing about 10 percent of people insured through Covered California to find a new health plan.
Anthem blamed a shrinking individual insurance market and uncertainty about future federal health care policy for increasing uncertainty that makes it hard to plan and price insurance policies.
"As the Individual marketplace continues to evolve, Anthem will continue to advocate solutions that will stabilize the market to allow us to return to a more robust presence in the future," Anthem spokeswoman Jill Becher said in a statement.
Avalere Health, a Washington-based consulting firm, reported last month that its analysis of 2018 rate filings in eight states found an average increase of 18 percent.
Obama's health care law provides two kinds of subsidies to help keep costs down for people with low to moderate incomes. Tax credits reduce monthly premiums for people who qualify. And payments to insurance companies cover a portion of their out-of-pocket costs, reducing the high deductibles and copays that are standard for plans in the individual market.
The latter payments, estimated at $7 billion a year nationally, have been challenged by Republicans in court, and Trump has refused to guarantee that he'll continue making them. As recently as Monday, he has suggested he could cut them off.
Covered California officials said rates for subsidized middle-of-the-road silver plans will increase an additional 12.4 percent next year if federal authorities don't provide assurances by late August that the cost-sharing payments will continue through 2018. Because the increase would affect only subsidized plans, the impact would primarily affect the federal budget with effects on consumers blunted, Lee said.
"It looks like the market in California is still stable despite some of the uncertainty that is causing a number of exits in other states," said Cynthia Cox, a researcher at the Kaiser Family Foundation.
