While Congress and the Trump administration really haven’t helped health insurers when it comes to what’s going to happen with the Affordable Care Act, it is reaching out to small business and is trying to ease their health insurance burdens. This is not only a big plus for small business, it could be a perk for the independent insurance agents of the PIA Western Alliance that sell health insurance.
Rule changes will go into effect starting January 1st next year that will allow small business to go around the marketplaces of the Affordable Care Act's Small Business Health Options Program (SHOP) and purchase insurance directly from an insurance agent.
The reason? SHOP hasn’t been very successful.
Selema Verma is the administrator of the Centers for Medicare and Medicaid (CMS). She said SHOP was expected to insurance millions but in reality has covered just 85,000 people from 11,000 small businesses.
“Our goal is to reduce ACA burdens on consumers and small businesses and make it easier for them to purchase coverage. The ACA has failed to provide affordable insurance to small business and to the American people. This new direction will help employers find affordable healthcare coverage for their employees and make the SHOP exchanges function more effectively,” she said.
Businesses will still have to go through HealthCare.gov to determine eligibility. However, insurers will be able to use their own enrollment systems going forth.
As for health insurers, Aetna said last week that it’s pulling out of the last of the ObamaCare exchanges. All that remains is Delaware and Nebraska. Financial losses and worries over more of them are the reason Aetna — and others — pulled out.
In the final pull out statement Aetna said, “Our individual Commercial products lost nearly $700 million between 2014 and 2016, and are projected to lose more than $200 million in 2017 despite a significant reduction in membership.”
Aetna isn’t alone. Insurers — says Kaiser Family Foundation health expert Cynthia Cox — are completely in the dark as to what the Trump administration and Congress are going to do with the Affordable Care Act. The indecision could lead to double-digit rate hikes in 2018 and some insurers — she noted — are already talking jumps of 50% or more.
“It’s a significant factor in pricing this year. I think it’s fair to say these rates are higher than we would have expected to see in the absence of uncertainty,” she said.
Meanwhile, the administration — via the Department of Health and Human Services (HHS) — is doing all it can to keep insurers in the market but Cox says that may not be enough.
“Insurers don’t really know which to believe. They don’t know whether to believe the signs Congress and the administration will work to stabilize the market in the short term or to believe the signs they will work to destroy the market,” she said.
California Insurance Commissioner Dave Jones is so unsure of what’s happening that he has asked insurers working in his state to submit two sets of rates for next year. One will be rates that assume ObamaCare will continue and the second is rates that assume TrumpCare will pass.
Source links: The Hill — link 1, link 2, Insurance Journal