By Joanne Kenen
Health insurance premiums obviously are going up – and we’re all, appropriately, writing about it. Affordability is a political issue, affordability is a consumer issue, and affordability is an economic sustainability issue.
But we need to do it accurately, not sloppily. Here are a few quick suggestions:
Income –Probe when someone tells you their income does or does not qualify them for subsidies. Have they checked – or are they making an assumption that subsidies are only for the very poor? A recent HHS report estimates about 2.5 million people are paying the full cost of an exchange plan, but could get subsidies.
Are they telling you their gross income? Do they understand that ACA subsidies are based on a modified adjusted gross income or MAGI (not the same as taxable income, but more of a first cousin)? Here’s a definition.
On or Off market – Are they shopping on the exchange (Healthcare.gov or their state’s exchange) or are they looking at off-exchange plans? Subsidies are available only through the exchanges.
Moreover, the exchange may display more choices – from more carriers – than going through one health insurer’s home page at a time, or by working with a broker or agent who may be tied to a certain carrier. (Given that some states no longer have much competition in the exchange, I don’t think more choices will be displayed on exchange for everyone, but it’s still worth checking.)
Consistent terms – Make sure you report apples to apples. It’s easy – but misleading – to quote someone saying something like, “My insurance used to cost $500 a month, but now it’s going to cost $8,000 a year.” That sounds like an astronomical increase – and it is a hefty increase – but if you do the math, it’s $6000 to $8000. That is certainly a lot – I’d be annoyed if mine went up that much! But when you have a $500 figure next to an $8000 figure, your readers are going to think it is even more.
Assertions about what’s covered. Be skeptical when someone tells you something like, “I’m paying $10,000 for a terrible Obamacare plan, and it doesn’t even cover my asthma.” Remember that plans cannot exclude pre-existing conditions, and have to cover essential benefits, including common conditions such as asthma. It is possible that an out of network specialist, a favorite doctor, or a certain brand-name drug is not covered – narrow networks and drug formularies are a reality and a challenge. However, don’t let people make blanket statements about not being able to get care for common conditions or get a common drug.
Deductibles – This is a tough one. They are big and getting bigger, but it doesn’t always mean zero coverage until the person pays the full deductible. Some health expenses may be covered. By law certain preventive care is free, no matter the deductible. It can be hard to know for sure, so chose your wording with care.
How to be accurate? Get help. I have read stories that just don’t sound quite right, but it is hard to tell without knowing precisely where someone lives, their age and adjusted income, their medical conditions and drugs they need.
A quick “window shopping” trip to Healthcare.gov can be a good reference point, but without the specifics can only tell you so much. Ask local navigators and assistance groups to help you report these stories accurately. (Check out this directory or search online for resources in your community.)
Unless you use broker or agent who you know very well and are confident they know their market inside out – and don’t have a financial interest in steering someone to a specific plan or carrier – I’d check with a few different brokers and agents, and run the broker’s recommendation through a nonprofit navigator/assister.
Also, it’s fair in these stories to note these points made by the administration and ACA backers:
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Most people are NOT getting covered through the exchanges. It’s around 10.5 million as of October 2016, according to HHS. The rest of us may get health insurance through their job, a family member’s job or a government program, such as Medicare and Medicaid. Those people likely are not seeing their premiums increase as much. Employer-sponsored insurance premiums are rising much more slowly, although deductibles may increase. See this Kaiser Family Foundation survey.
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Most people using the exchange also are receiving subsidies, and so are not paying the high sticker prices being reported.
It’s also fair to note the following points made by ACA critics, which are shared by some ACA supporters who acknowledge the weaknesses:
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About 7 million people (I have seen estimates ranging from 5 to 9 million) are in the individual market, and may not be eligible for subsidies, possibly because their income just above the cut-off point. They can face huge obstacles to finding affordable coverage and end up paying a lot. They may be exempt from the individual mandate on economic grounds, but that does not mean they don’t want, need or deserve coverage. According to KFF about 3 million of the remaining uninsured population do not qualify for subsidies. Plus, there’s an additional 2.6 million uninsured who would be eligible for expanded Medicaid if their states opted to make it possible. So when the administration correctly points out that most exchange clients get financial help, remember that these 7 million still don’t.
- The higher subsidies, which are based on now higher premiums, do come out of tax dollars. The impact does ripple.
