Lost among the Affordable Care Act's successes, such as reducing the number of uninsured to historic lows, there exists a small group of people who get hammered each year by huge premium increases. But 2017 will be different. It actually will be much worse.
Dr. David Butler, a Baton Rouge veterinarian, said if he and his wife keep the same Blue Cross and Blue Shield of Louisiana plan they had in 2016, the premiums will jump 50 percent to $2,400 per month.
"It's terrible. Right south of $30,000 a year for two people, 60 years old, nonsmokers, no health issues," Butler said.
And the extra kick in the wallet: Instead of separate $4,500 deductibles, the Butlers will have a single $9,000 deductible to meet before their insurance kicks in, with the exception of some wellness visits. Basically, Butler and his wife potentially would have to spend close to $38,000 for the year in premiums and the deductible.
Not surprisingly, Butler is unhappy with the current situation. Before the Affordable Care Act, commonly referred to as "Obamacare," he bought coverage through the American Veterinary Medical Association. He was happy with that plan and wanted to keep it, but the federal law eliminated that option, despite promises to the contrary.
The open enrollment period for individual 2017 Obamacare health plans begins Nov. 1 and ends Jan. 31. Federal officials say they expect enrollment to grow by about 9 percent nationwide to 13.8 million people.
Butler is part of a small group of Louisiana residents who buys individual health plans but don't qualify for financial assistance under the Affordable Care Act. Louisiana residents who buy coverage through the online Health Insurance Marketplace can get federal subsidies if they make between 138 percent and 400 percent of the federal poverty level. For a family of four, 400 percent is $97,200; for a couple, $64,080.
The most recent 2016 enrollment numbers for Louisiana show 184,403 people bought coverage through the federal online marketplace, according to the Centers for Medicare and Medicaid Services. Of those, 92.6 percent received a financial subsidy to offset most of the cost of premiums.
The subsidies largely protect the consumers who qualify for them from rate increases, according to the U.S. Department of Health and Human Services. The tax credits increase dollar for dollar with the cost of the insurance plan.
For example, a 27-year-old in New Orleans who will make $25,000 and buy the benchmark plan for 2017 will pay $1 less a month than in 2016, according to a Kaiser Family Foundation report. While the total premium will jump $41 to $373 per month, the tax credits will increase $42 to $166 per month.
The subsidy increases are important in Louisiana, where insurers plan to raise 2017 individual health plan premiums an average of between 16.4 percent and 30.75 percent.
Insurers say the increases are necessary because they are losing millions on the Obamacare plans, in large part because the people buying coverage are sicker than expected; healthy people aren't enrolling because the penalties for not signing up are so light; and a federal program designed to limit insurers' losses lacked funding.
Blue Cross and Blue Shield said it will lose close to $60 million on the plans this year. The insurer has lost more than $200 million in the past three years. UnitedHealth pulled out of Obamacare in Louisiana for 2017. Now, only Blue Cross, Vantage Health and Humana remain.
Meanwhile, there's no protection for small-business people like Robert Stern of New Orleans, a physicians practice management and electronic medical records consultant.
Stern saw his rates increase by 100 percent from 2013, the year before the Obamacare rollout, to 2016. The premium for a policy to cover only Stern swelled to $1,025 per month for 2016, although his deductible was a relatively manageable $1,700.
The Affordable Care Act was supposed to help middle-income people, too, but they're being left out and getting hurt by skyrocketing health insurance costs, Stern said.
"The people who do have these plans have insurance," Stern said. "But they don't have health coverage because they can't afford to meet the deductibles, co-insurance and/or out-of-pocket max associated with many of these plans."
Baton Rouge resident Linda Wunstel, who doesn't qualify for subsidies, has delayed hip surgery for more than six months because her annual deductible is $4,500. She plans to have the procedure in December, when she becomes Medicare-eligible.
Last week, President Barack Obama admitted the lack of protection for middle-income Americans is a problem. He recommended using some of the billions in savings the ACA has generated to provide tax credits for more middle-income families and to help young adults buy insurance.
For now, HHS is advising consumers to shop for coverage. If every Louisiana consumer who's already enrolled selected the lowest-cost plan available within their current coverage level, average premiums would drop $23 per month, or 20 percent, from 2016 to 2017, the agency said.
Still, it's unclear how much help shopping around offers to those who don't qualify for subsidies.
"It's just kind of insane the way those rates are just going to continue going through the roof," Butler said.