Health Overhaul

The government reported this week that 2.3 million consumers nationwide have picked a 2018 plan on Healthcare.gov., 34 percent more than at the same point a year ago. About 566,000 of those are new enrollees. State-specific numbers aren't provided, but officials said sing-ups in Louisiana are on the upswing as well.

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Although state-specific numbers aren't available, Louisiana enrollment in Affordable Care Act health plans appears to be higher so far this year than last — with many paying little or no premiums and others who are ineligible for government subsidies facing staggering increases or higher deductibles.

"What we know is that we're busier this year than we've ever been before, and it is a lot of new people," said Brian Burton, state director for Navigators for a Healthy Louisiana.

Experiences for a couple of people signing up for so-called Obamacare health plans vary from a $1 a month increase for Gonzales resident Lacey Lanoux, who has an office and home cleaning service, to Lawrence "Sonny" Borne, a retired pipefitter from St. Amant, who's monthly premium is covered but deductibles and medication costs are overwhelming.

"I might have to go work part time or something to try and help pay for this," Borne said.

For Lanoux: "It's incredible. It's too good. I'm waiting for something to backfire, but it seems too good to be true. I'm highly satisfied."

On average, premiums for Louisiana health plans available through Healthcare.gov will increase 18.5 percent for 2018. However, about 90 percent of Louisiana consumers who enrolled in plans for 2017 received some form of taxpayer-funded financial assistance. For most of them, the financial assistance will offset the increase in premiums for 2018.

The government reported this week that 2.3 million consumers nationwide have picked a 2018 plan on Healthcare.gov., 34 percent more than at the same point a year ago. About 566,000 of those are new enrollees.

Two Louisiana companies, Blue Cross and Blue Shield of Louisiana and Vantage Health Plan, offer Obamacare coverage through the Healthcare.gov online federal marketplace. Last year, about 123,000 Louisiana residents enrolled in Obamacare plans.

Vantage Health spokesman William J. Justice said enrollment is up slightly so far, and the company is seeing "a significant amount of activity."

Blue Cross said it will not comment on its 2018 enrollment numbers until January.

Health insurance officials say enrollment has accelerated because consumers know they have less time to pick a plan, and groups connected to the Affordable Care Act are pushing to get people enrolled. Open enrollment began Nov. 1 and ends Dec. 15. Last year consumers had 12 weeks to enroll.

Burton said community groups, most of them affiliated with the Democrats and opponents of Republican efforts to repeal the Affordable Care Act, also are helping drive enrollment. Federal funds to the two navigator groups in Louisiana that help consumers enroll in ACA plans were cut 80 percent this year, and community organizations are picking up the slack.

"These are the guys that said 'We want to continue our health care' and they won," Burton said. "And so now they're like, 'We worked hard to keep this. Now we've got to get the word out and make sure people know about it.'"

Consumers who qualify for government subsidies face minimal increases in their premiums and are sticking with their Silver plans, which cover 70 percent of costs after deductibles, Justice said. But people who make too much money to qualify for a subsidy are scrambling to find an affordable option.

Burton and other health insurance experts say lots of consumers actually will pay no premiums for their coverage in 2018. The reason?

In an effort to weaken Obamacare, President Donald Trump stopped direct payments to insurers for reducing lower-income consumers' out-of-pocket costs for Silver plans.

Insurers anticipated the end of the cost-share reductions, so they upped the premiums on Silver plans — putting the federal government in the position of paying increased subsidies tied to the cost of Silver plans.

Greg Town, president of Baton Rouge health insurance agency Enroll.US, said 15 percent of the more than 1,500 consumers his company has enrolled in Obamacare plans won't pay any premiums in 2018. Seven percent of the zero-premium consumers picked Silver plans; 8.3 percent picked Bronze plans, which cover only 60 percent of costs after deductibles.

Louisiana consumers who earn 138 percent to 250 percent of federal poverty level qualify for a cost-share reduction, Town said. So Silver plans become "amazing," with monthly premiums of $15 to $60, depending on the person's age.

For example, Lanoux's Silver plan at Blue Cross went up $1 to $46 a month in 2018 for the same coverage, and her plan's deductible is $100.

Burton said when insurance companies sent out letters notifying consumers about the 2018 premiums, the insurers didn't include information about the increase in financial assistance.

"So many consumers are coming to us because they're freaking out, and then we sit down with them, and they walk out singing, 'Oh Happy Day' because they’ve got insurance that was better than it was in 2017 and they're paying less for it," Burton said.

But the 10,000-plus Louisiana consumers who make too much to qualify for financial assistance are singing a far different song. So are a number of older consumers whose health plans cover only a portion of soaring prescription drug costs.

Josh Ford, owner of Giraphic Prints in Baton Rouge, had to find a replacement for the Bronze Humana plan he paid $106 a month for this year. His new Blue Cross plan, which offers worse coverage, will cost him $310 a month.

Ford said he looks at his health insurance as essentially a tax.

Borne, the retired pipefitter, said health insurance is a near impossibility. Borne is 61 and diabetic. He and his wife are covered by a Blue Cross plan that covers 90 percent of costs and carries a $600 deductible per person. The Bornes' 2017 premium is $153 a month. But the plan won't be available in 2018, and the closest plan Blue Cross offered covers 80 percent of costs, has a $3,200 deductible per person and a monthly premium of $371.

Borne worked with B. Ronnell Nolan, president and chief executive officer of Health Agents for America, to find another option.

The best they could do was a plan that will cover 70 percent of costs and includes a $4,500 deductible. On the plus side, the $2,155 the Bornes receive in financial assistance will cover their monthly premium.

The problem for Borne is that the medications he takes to treat his diabetes have cost about $250 a month, but his doctor has prescribed a new combination medication that costs close to $6,500 a month. Under Borne's new plan he will have to cover the first $4,500 worth of medication.

Borne said the cost for his medication may mean the end of his retirement.

"I've got my bills to where I can kind of make it on what I'm getting on retirement. After taxes and that, I get $3,000 a month," he said. "Paying these prescriptions out of my pocket like I'm going to have to do next year, I don't know. I'm going to have to try to work something out. I might have to go work part time or something to try and help pay for this."

Nolan said she was dismayed by the Bornes' situation, and lots of others are in the same boat.

Finding the "best" option can take hours and require lots of conversations and research, she said. Among other things, people have to talk to their doctors about whether they can afford their medication, whether there are discounts or samples available, then find the pharmacy where the medication is cheapest.

"The plans are horrible," Nolan said. "There's no reason a plan with a $4,500 deductible should cost over two grand. It just shouldn't."

Follow Ted Griggs on Twitter, @tedgriggsbr.