By Richard Cauchi
The first days of November mark more than the elections. Health marketplaces or exchanges open in all 50 states and D.C. for sales of health insurance, as authorized by the Affordable Care Act.
With 11.6 million currently signed up for 2016, the fourth year of coverage brings anxious questions, opportunities and challenges for residents in every state and community. It also sharpens the focus on what your state may do in response.
This year’s window for signing up starts Nov. 1, 2016, and ends Jan. 31, 2017. Scary headlines set the stage in many areas. “Double-digit hikes; fewer plan choices” notes AP. “Some rates rise 25%” says USA Today. “Scores of … policies will be discontinued” highlights the Wall Street Journal.
But the federal Department of Health and Human Services highlights a different feature: “More than 70% of consumers can find marketplace plans for less than $75 per month.”
How It Will Work in Your State or District
Legislators and staff often get health coverage questions from consumers. Health plan choices and costs always vary a lot depending on region and family income. Here are three resources that can provide short-cuts to state examples and actual plans available for comparison and purchase.
Employer-based Coverage Is Different
For most of the 156 million Americans with employer-sponsored health insurance, the situation is different and more stable. Deadlines for decisions vary locally and most terms are set by employers and insurers.
A new report, by the Commonwealth Fund, “The Slowdown in Employer Insurance Cost Growth: Why Many Workers Still Feel the Pinch,” found that families spent an average of 10.1 percent ($6,422) of their income on health insurance premiums and deductibles in 2015. But there were differences among states.
- In Mississippi, which has the lowest median income and among the highest health insurance contribution levels, families were at risk of spending 14.7 percent of their income, on average, on health insurance costs.
- Families in the District of Columbia and Massachusetts had the lowest health insurance costs as a share of income, at 6.8 percent and 7.3 percent, respectively.
2017 Legislative Roles?
When legislatures reconvene this winter, several options exist for consideration to affect the state’s health insurance functions. As Brian Webb, assistant director at National Association of Insurance Commissioners. told an NCSL audience on Oct. 28, 2016, “States are still in charge—you can still do a lot.”
The discussion session listed state-based rate review and approval, response to consumer complaints and appeals, provider network adequacy, more information on prescription drugs, balance or surprise billing, and possible Section 1332 waivers to alter some of the federal requirements for individual and small group coverage. As the saying goes, “stay tuned.”
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Richard Cauchi is a program director in NCSL’s Health program.
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