Semro column: No, the ACA isn’t in a death spiral
In our overpoliticized health-care debate, it’s easy to forget where we were and how far we’ve come.
According to the latest Colorado Health Access Survey, the number of uninsured Coloradans dropped from 829,180 in 2011, the year after the Affordable Care Act was passed, to 352,664 in 2017. In Health Statistical Region 12, which includes Garfield, Eagle, Grand, Pitkin and Summit counties, the number of uninsured dropped from 44,283 in 2011 to 17,742 six years later.
Perhaps no other indicator shows the financial value of health insurance coverage more than the decrease in personal bankruptcies tied to health-care debt in Colorado. In 2013, there were approximately 104,000 bankruptcies linked to health-care debt. In 2017 that number dropped to 40,000, a decrease of 60 percent in four years. That statistic clearly shows the gains that we’ve made, the importance of insurance coverage and the economic consequences of being uninsured.
But the consequences of being uninsured go far beyond the financial. Without insurance coverage and regular access to health care, problems that could be identified and treated remain undiscovered and unresolved. And that can lead to far greater damage than medical bills.
The latest open enrollment period for signing up for coverage in the individual health insurance market began on Nov. 1. If you only listen to cable TV, you might not know that the open enrollment period in Colorado doesn’t end on Dec. 15, but continues through Jan. 12, 2018.
Colorado’s health insurance marketplace, Connect for Health Colorado (C4HC) was set up by the state and as a result didn’t suffer some of the regulatory and funding problems inflicted upon the federal marketplace by the Trump administration. C4HC has adequate public education funding, and a grant from the Colorado Health Foundation has made money available for health coverage guides (also called navigators) who directly help consumers. In contrast, for non-state marketplaces, the administration cut the open enrollment period in half while simultaneously slashing educational funding by 90 percent and navigator funding by over 40 percent.
The Trump administration’s decision to defund Cost Sharing Reduction Payments (CSRs), which was suspiciously announced just before the start of open enrollment, didn’t create the chaos in Colorado that we saw in other states. Thanks to advanced planning from the Colorado Division of Insurance, C4HC and Colorado insurance companies, alternative plans were drawn up to meet whatever option the administration decided to take. As a result, massive premium increases were not imposed at the last minute and carriers didn’t feel compelled to leave the market. According to DOI, the administration’s decision on CSRs will lead to an average additional 6 percent increase for 2018 premiums, far less than in other states.
In Colorado, tax credits to buy insurance will increase to compensate for those higher premiums and drug costs. The average monthly tax credit in Garfield County increased from $447 in 2016 to $642 in 2017, an increase of 44 percent. That’s a trend that will continue as long as the ACA remains the law.
Prior to this open enrollment period, more than 60 percent of Colorado enrollees were eligible for premium tax credits with non- tax credit enrollees representing about 35 percent of the total.
Unfortunately, far too many Coloradans are unaware that they’re eligible for these tax credits which can make coverage more affordable. Eligibility information is available at C4HC’s website connectforhealthco.com. On that site, consumers can find health coverage guides and enrollment options in their area.
Garfield is also one of 12 counties that saw their number of plan selections increase by 10 percent or more. At the end of the last open enrollment period, the number of Garfield county enrollees in the C4HC private insurance marketplace stood at 2,667. That total has increased every year since the marketplace began operation.
While the president continues to assert that the marketplaces are imploding, states like Colorado are pushing forward in the face of political uncertainty and the regulatory and funding hurdles that are being thrown in their way. According to reporting from the nonpartisan Congressional Budget Office and Standard & Poor’s, the ACA individual market was showing signs of improvement with real profitability likely in a couple of years. Both organizations concluded, contrary to the political rhetoric, that the ACA individual market was not in a “death spiral.” But every time something new and disruptive is thrown into the system, the path toward stability in this new market is put in jeopardy.
In the first four days of this open enrollment period, 600,000 Americans signed up for coverage through the state and national marketplaces. That’s almost double the number of enrollees compared with the same time last year, and 138,000 are new customers. It’s a good start. The need and the demand are there. It’s time to start building up and stop tearing down.
Bob Semro of Glenwood Springs is a former health policy analyst for the Bell Policy Center, and a legislative and senior advocate.