The fight for enhanced premium tax credits hit a standstill by the end of Open Enrollment, leaving millions of Americans without affordable options to maintain their access to essential coverage and care. Current enrollees are set to see spikes in their premiums by an average of 114%, at least doubling the cost of care for millions. With the failure to address expiring enhanced premium tax credits, advocates will continue to work toward retroactively extending these critical supports. Without them, we expect uninsured rates to skyrocket, and higher costs for those that remain as insured enrollees represent a more concentrated pool of higher-needs consumers.
Even those who have re-enrolled in the ACA Marketplace may be unable to pay for their care in the months ahead. Without a clear plan for what happens next, affordability is in limbo for people with disabilities who may have accepted high-deductible plans in order to retain coverage. A recent Kaiser Family Foundation (KFF) Health Systems Tracker piece covered the tradeoffs that enrollees made when choosing between silver and bronze tier plans with the end of ePTCs. In this blog we’re looking deeper into the healthcare proposals on the table, and what they might mean for the disability community.
Last week, the Trump administration proposed a plan that would send “money directly to the American people” to handle their healthcare costs as a way to lower insurance premiums. Rather than ensuring adequate coverage, this proposal continues to emphasize Health Savings Accounts (HSAs) as an alternative to comprehensive insurance coverage. The details of this proposal are still vague as to how HSAs would be handled. As KFF points out, there have been competing proposals for how HSAs could be implemented, with the possibility that they could be applied to short-term plans that discriminate against enrollees with certain conditions.
KFF outlines some critical questions that remain to be addressed in how the current proposal might impact ACA protections for pre-existing conditions:
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Is it only the enhanced premium tax credit dollars that would be converted to a savings account, or are other taxpayer subsidies included in the “extra”?
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Who is eligible for this financial help and how would it be calculated and dispersed? Who will end up paying more and who will pay less?
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Would the funds be limited to out-of-pocket costs only or be used for premiums?
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Would any savings account money be in addition to or in lieu of premium tax credits, and would enrollees have a choice?
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Would this new financial support be available only on the ACA Marketplaces or could it be used to purchase health insurance that discriminates against people with pre-existing conditions, potentially leading to instability in the ACA Marketplace?
It is this final question raised by KFF that is especially troubling for long-term coverage options for those with disabilities. If this new financial support would be able to be used to purchase non-ACA compliant plans, it could lead to a large number of healthier enrollees leaving the ACA marketplace in favor of cheaper “junk” plans. This would then leave only those who need the consumer protections included in ACA plans, including people with disabilities who need to make sure that they are not underwritten based on their medical condition and who need access to the essential health benefits covered in ACA compliant plans. If only those individuals with higher medical needs are included in the ACA compliant plan risk pool, it will cause the premiums on those plans to skyrocket making them largely unaffordable for people with disabilities.
Another call to address affordability and transparency concerns has formed proposing a Health Care Bill of Rights, calling for a cap on premiums and a ban on junk plans that fail to offer adequate coverage. Ultimately, many questions remain about how to ensure comprehensive care for all that accounts for the needs of people with disabilities and chronic conditions.
There are reports that bipartisan negotiations are still continuing on trying to extend the enhanced premium tax credits, but as of the writing of this blog post, there is no framework for a bipartisan deal in place. If one is reached, there very well may be a special enrollment period to allow those to enroll in coverage who had opted not to due to the increased premium costs. AAHD will continue to monitor this as it develops.