Open Enrollment has ended, marking a turn toward Medicaid enrollment and Special Enrollment Periods for those that qualify. Despite a lengthy Congressional shutdown on the issue of extending enhanced premium tax credits, the future of these essential subsidies has not been decided, leaving healthcare affordability unresolved for millions. Access to comprehensive health coverage is still without a clear path forward, causing affordability and access challenges for people who need care.
Recent reporting on the rise in ACA Marketplace premiums highlights the choices that people with disabilities are making to continue to access healthcare:
Some enrollees, like Salt Lake City freelance filmmaker and adjunct professor Stan Clawson, have absorbed the extra expense. Clawson said he was paying just under $350 a month for his premiums last year, a number that will jump to nearly $500 a month this year. It’s a strain for the 49-year-old but one he’s willing to take on because he needs health insurance as someone who lives with paralysis from a spinal cord injury. [PBS News report]
Dave Roff and his wife Thea may be forced to pay $1,800 a month for her Obamacare insurance if Congress fails to extend enhanced plan subsidies that expired Dec. 31. […] The Roffs said Thea was on a bronze plan last year, with a $280-a-month premium, which jumped to $450 this year. But Dave said that plan was too expensive for the limited medical access it provided. They chose a gold plan for this year that would cost $733 a month instead of $1,800 if Congress had extended the subsidies. Dave said he was taken aback when he first saw the higher prices. […] Dave said Thea must have health insurance due to several chronic health conditions. She’s currently suffering from diabetic retinopathy, which is a complication from diabetes that damages blood vessels in the eye. “She has to continue getting those treatments or she’ll go blind,” he said. “It’s not the kind of thing that we can play with too much. We really have to have something in place for her.” [WHYY report]
These stories illuminate the trade-offs that people with disabilities in particular are having to make to retain their coverage, despite hikes in premiums.
In a recent blog, AAHD reviews the dominant proposal now being considered to address the healthcare affordability crisis. While nominally taking on drug pricing and premium costs as key concerns, the Trump administration proposal continues to undermine comprehensive insurance, instead calling for the diversion of funds into Health Savings Accounts (HSAs), which do not ensure the coverage people with disabilities need. Despite demonstrated affordability challenges in our healthcare system, the Center for Children and Families at Georgetown points out that cash spending accounts fail to meaningfully replace traditional insurance. For people with disabilities in particular, the proposal leaves many questions around comprehensive care access unanswered. Efforts to reinstate enhanced premium tax credits to maintain insurance are continuing. In the months ahead, Marketplace enrollees will bear the costs of lower premium plans like the bronze tier option, which has higher out-of-pocket costs baked in when utilizing care.
Kaiser Family Foundation’s executive vice president for health policy, Larry Levitt, warned about the effect of policy programs which divert funding into HSAs, stating: “healthy people could get much cheaper insurance that has medical underwriting and doesn’t cover preexisting conditions, but that would leave much sicker people in the ACA pool, and likely send it into a death spiral.” Without the protections in the ACA, people with disabilities will struggle again to find coverage.
Healthcare affordability continues to be a dominant issue across the country. Some states are trying to support consumers with premium subsidies, though these supports might not be sustainable. As states determine how to balance their budgets to cover Medicaid in the coming year as well, some are also taking action to cap hospital pricing, which has been a large driver of healthcare costs
Archives of our weekly updates are available on the NDNRC website. Follow AAHD’s other newsletters to stay current on research opportunities and policy developments supporting people with disabilities.