The NCSL Blog


By Mark Wolf

When considering the future state of health insurance, Representative George Keiser (R-N.D.) says he's never wanted a crystal ball more than right now.

Senator Deb Soholt moderated the Forum session on health insurance. NCSL photo by Berkeley Teate."But I'm not sure it would help," said Keiser, during an NCSL Capitol Forum session considering "What is Happening With Health Insurance Now?"

Keiser spoke at the end of a session in which a panel discussed a wide range of issues that are affecting the market for Affordable Care Act coverage. 

Sara R. Collins,  vice president, health care coverage and access for the Commonwealth Fund, cited several major federal health care developments this year:

  • The Trump administration’s decision to end cost-sharing reduction (CSR) payments.
  • Cuts in advertising and navigator funding and the enrollment period shortened by 45 days.
  • Repeal of the individual mandate, in the Senate-passed tax bill.
  • Executive orders to extend short term insurance policies to 12 months and increase access to association health plans.
  • New regulations for 2019 marketplace plans may allow states greater flexibility to determine what health plans cover.

Without the CSR payments, she said, insurers had no choice but to increase rates for silver plans and premiums rose 20 percent, she said. What happened was that states developed a workaround by allowing carriers to increase premiums on silver plans of which 85 percent is mostly covered by the federal government. That meant the federal government was going to pay more than it would have had they funded the CRS.

The changes to the Obamacare enrollment procedures were expected to lead to a lag in coverage, but, Collins said, enrollment is up about 22 percent and "there will likely be a surge at the end of enrollment" that will bring enrollment close to last year's level.

The Congressional Budget Office, she said, estimates premiums will rise on average about 10 percent for 2019 if Congress repeals the individual mandate. Short-term plans "are buyer beware for sure," said Collins.

John Bertko of Covered California Health Exchange cited a recent report saying health care costs keep rising but only went up 4.5 percent for 2016. He said if a bill sponsored by Senators Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) passed, rates would drop about 20 percent. 

If the individual mandate is repealed, Bertko said he expected California lawmakers would probably rush emergency legislation establishing a state mandate, although most states probably would not follow suit. He said studies have shown that the effect of "free money" premium subsidies overwhelms the effect of the tax savings of a mandate repeal.

Keiser said he believed the current administration was honest and sincere about wanting to cede authority to the states: "You will be required to design a plan for your state and you better be ready for it."

Mark Wolf is editor of the NCSL Blog.

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This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.