Open enrollment for 2017 health coverage commences in less than a week amid critical issues involving outreach, risk management and consumer options.
Below are six pressures affecting the ACA's fourth annual open enrollment, according to an Avalere report.
1. Insufficient penalties relative to coverage cost. For a 27-year-old earning about $24,000 annually — or 200 percent of the federal poverty line — a low-cost silver exchange plan would cost $1,523 in premiums. Penalties, on the other hand, would total $695, according to Avalere.
2. Shrinking exchanges. In 2011, the Congressional Budget Office predicted 2016 ACA exchanges would have 22 million enrollees. Recent HHS data found for the first half of this year, ACA exchanges had 10.4 million enrollees. Last year, more taxpayers — 12.4 million — claimed exemption from the ACA's individual mandate than enrolled in exchange coverage.
3. Lack of young, healthy consumers. A recent Avalere study found individuals 55 and older reflected about a quarter of exchange enrollees while representing 16 percent of the eligible population.
4. Concluding risk corridor and reinsurance programs. Two temporary programs created under the ACA to stabilize insurance markets — risk corridor and reinsurance — will end this year. While many insurers touted insufficient risk corridor payments as causing their market exits, reinsurance payments could have lowered premiums by about 10 percent, according to Avalere.
5. Significantly higher premiums. HHS said premiums for the second-lowest cost silver "benchmark" plan will increase by an average 25 percent on federal exchanges and 22 percent on state exchanges next year. Indiana will see the lowest premium change with an average 3 percent decrease, and Arizona will shoulder an average 116 percent increase. Eighty-five percent of enrollees are eligible for subsidies and will not see the bulk of increases.
6. Less exchange competition. Twenty-one percent of enrollees will have only one exchange insurer from which to choose 2017 coverage. Nationwide, 2.9 health plans will be available per county in states using HealthCare.gov, while 5.3 plans per county were available this year.
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