Health Overhaul Signups

The Healthcare.gov website is where people sign up for health insurance coverage on the federal exchange under the Affordable Care Act, known as Obamacare. Rates in Louisiana for 2019 are dropping an average 6.4 percent.

Coming off some changes surrounding the Affordable Care Act this year, the six-week open enrollment period for the individual market begins Thursday for the more than 100,000 Louisianians who receive health coverage through the federal exchange.

The open enrollment period runs from Nov. 1 to Dec. 15 to put coverage in place for 2019, and the only way to enroll through the federal exchange after that is by qualifying for a special enrollment.

For the first time since the inception of the health law, commonly known as “Obamacare,” the individual market in Louisiana will see premiums drop on average after Blue Cross and Blue Shield of Louisiana and Vantage Health Plan slashed rates following a profitable 2017.

Also a first: People are no longer required to buy health insurance after President Donald Trump's administration and Congressional Republicans repealed the so-called individual mandate provision of the ACA starting Jan. 1, 2019. Previously, those without insurance faced a paying a penalty.

Despite those changes, and other regulatory moves by the Trump administration that could undermine the health law, Brian Burton, head of the Southwest Louisiana Area Health Education Center, is assuring people the open enrollment period is moving forward as scheduled.

“People think that because the individual mandate ends on Jan. 1 that the marketplace is closed,” Burton said. “I keep hearing that a lot.”

The marketplace is very much open, Burton notes, and despite the drop in rates, some enrollees may pay slightly more — usually $10 to $20 more a month — than last year because federal subsidies also decreased.

On average, rates in Louisiana are dropping by an average of 6.4 percent, according to the state Department of Insurance. That drop comes after years of double-digit rate hikes. 

Burton recommends people shop around for plans this year, even if they are scheduled to be automatically enrolled into their existing plan. Those who don’t get federal help should check out some of the bronze and gold plans before giving up and leaving the market.

Burton’s group serves as Louisiana’s sole statewide “navigator” organization for the marketplace. The Trump administration last year slashed Louisiana navigator funding from $1.5 million to about $297,000, according to the Kaiser Family Foundation. Burton’s organization is receiving slightly more — $300,000 — this year to assist enrollees.

People making between 138 percent and 400 percent of the federal poverty line, which is between roughly $16,600 and $48,000 for an individual, are eligible for federal subsidies to help pay for health insurance. Those making less than 138 percent of the poverty line are eligible for Medicaid.

According to data from the Centers for Medicaid and Medicare Services, 93,865 of the 109,855 people who enrolled in 2018 — 85 percent — received federal aid offsetting the cost of premiums. While the average premium cost this year was $648, the average cost after factoring in federal tax credits was $201.

The Trump administration this year also expanded access to short-term health plans and Association Health Plans, moves that proponents argue give consumers more choice but which critics say will undermine the Affordable Care Act. Some have worried the individual mandate repeal will also drive healthy people out of the individual market, driving up costs.

Meanwhile, several Republican attorneys general, including Louisiana's Jeff Landry, are suing to repeal the Affordable Care Act, including the part of the law that protects people with pre-existing conditions.

A study by the Kaiser Family Foundation found that even though premiums are dropping in the individual marketplace throughout the country, they cost 6 percent more on average than they otherwise would if several changes, including the individual mandate repeal and expansion of short-term plans, had not been made.

“Repealing the mandate penalty and expanding the availability of short-term plans and association health plans effectively siphons healthy people from the ACA marketplaces, driving up premiums as insurers’ risk pools include a larger share of sick people relative to healthier ones,” the foundation said in a news release.

Danielle Blanchard, public information officer at the Louisiana Department of Insurance, said while healthy people leaving the market because of the individual mandate repeal is a risk, Louisiana’s insurers “are not as concerned with the possibility of that fluctuation.”

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Follow Sam Karlin on Twitter, @samkarlin.