Uncertainty Is Certain in 2018 Healthcare

Wow, this has been an exciting week – the health care bills / withdrawals / repeals abound, but no resolution is in sight.

We do know that repealing the Affordable Care Act (ACA) will leave millions more without health coverage than under the current regulations – the CBO put the number at 32 million by 2026 (but, we’ll also lower the deficit by $473 billion).

While that does not seem to have support from the Senate, the uncertainty of the health care regulations is creating a lot of turmoil for insurance companies. How can you plan for the future, when the future of the health care rules might change?

NPR and Kaiser Health News (KHN) set out to see how much this uncertainty is costing consumers. If you were not aware, the insurance premiums were due to the respective state insurance boards in June. Many companies have been asked to revisit their rates and make adjustments, but what does all of this uncertainty do to the pricing?

A lot depends on the Federal subsidies in the marketplaces. If the current administration stops these subsidies in an effort to “gut Obamacare markets,” it will eliminate the “affordable” out of the Affordable Care Act for millions of Americans and many (especially healthier) people will be forced to drop their coverage due to the sharp premium increases.

It ends up, this uncertainty may cost consumers a lot next year. Per the NPR / KHN report, “In Pennsylvania, premiums next year without the subsidies would increase by an average of 20 percent, compared with 9 percent if they remain intact.”

The Pennsylvania Insurance Department further states that “Statewide average rate increases will be 36.3 percent if the individual mandate penalty is eliminated and cost-sharing reduction funding is also cut off.”

Average premiums in Pennsylvania in 2017 (without subsidies) are $533/month. That means, 2018 may have the following average premiums for those in Pennsylvania:

ACA Chart 2018

That’s just one state’s projections, and keep in mind that these are average statistics in Pennsylvania. Some will experience less and some more that what is noted above.

I am not sure who could lose their up to 64% subsidy (average of $340/month or $4,080/year in 2017) and then potentially shoulder an additional $2,300+ premium increase next year due to policy changes. That could be about $6,400 in additional premiums next year alone.

It does look like there may not be a full understanding of what health care premiums are from our current leader. I think $12-a-year premiums sound great, but even those of us with employer subsidized coverage don’t have that kind of deal.

Whatever the future holds, I hope we do not take coverage away from millions, either through mandate or affordability. Many employers are also struggling with affordability issues, and certainly do not receive any Federal assistance.

I do agree that all sides need to come together and come up with something to help fix the situation we are now in. There will be winners and losers in this process, but keeping the uninsured as the ongoing loser hardly seems fair.

However, this uncertainty may kill us before we ever get there…

AHCA Pulled

Well, the big plan to replace the Affordable Care Act (ACA) did not happen, so what is an employer to do?

The good news is that you are (hopefully!) already doing it. Keep on keeping on!

The bad news is that all of that relief you were seeking from the AHCA is now gone, so we need to continue onward with the ACA for now.

First, keep up with your reporting and all other ACA requirements. I know the IRS does not require individuals to report their insurance coverage on their tax forms anymore, but you are still required to report to individuals and submit your federal filing on time.

Next, think ahead. The dreaded “Cadillac Tax” is still looming large in 2020. That means that the 40% excise tax for more generous medical benefits is still out there, and you should probably be planning toward falling under the limits in 2020.

What does that mean? Right now we are not so sure. We do know that the prior limits that were originally set to go live in 2018 will be indexed for the future implementation dates. However, we don’t yet know exactly what they will be. The 2018 limits were $10,200 for individual coverage, and $27,500 for family coverage, so using those numbers are the best bet for now.

We were also promised some relief to adverse selection including some allowance for an older/sicker workforce. That sounds like a step in the right direction, but still makes planning for 2020 difficult, at best.

My guess is that the 2020 implementation will be further delayed, as we debate the ongoing ACA (or any replacement) and how we pay for these now entitled benefits. Employers need to stay on top of compliance issues, and not bury heads in the sand. The year 2020 will be here sooner than any of us want.

Stay tuned and thanks for reading.