The individual health marketplace program offers income-based, taxpayer-subsidized private health insurance plans for people who aren't covered on the job.

Enrollment in the individual health care exchange in Louisiana has shrunk for the fifth year in a row, attributed in part to a continuing shift to Medicaid as people lost jobs to the coronavirus-inflicted recession.

Enrollment in the Affordable Care Act's individual market, known as Obamacare, fell to 83,159 this year from 87,748 policyholders last year. The program offers income-based, taxpayer-subsidized private health insurance plans for people who aren't covered on the job.

At its peak enrollment, there were 214,148 Obamacare policyholders in the state in 2016.

In 2016, Louisiana expanded Medicaid, a health insurance program for the poor that opened up another option for Obamacare policyholders.

"As soon as Medicaid was expanded, about 50% of our individual (marketplace) clients left," said B. Ronnell Nolan, president and CEO of the Health Agents for America. "There's been more demand this year because of COVID. We are fielding a lot more calls," she said.

During the pandemic, many Louisiana residents lost jobs and reached out to weigh their options as demand for guidance increased. Ultimately, many found they qualified for Medicaid, especially those who were unsure if they had a job waiting for them in 2021, Nolan said.

Louisiana followed a national trend. Obamacare enrollment nationwide dropped to 8.25 million this year from 8.28 million last year in the 38 states that, like Louisiana, use the federal HealthCare.gov website.

Increased cost could be a factor in the marketplace's enrollment decline.

Last year, health insurance premiums went up an average of 10% in the individual marketplace in Louisiana.

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"Blue Cross and other insurers price health care premiums for each year by estimating the costs of health care services members will need," said Mike Bertaut, health care economist for Blue Cross and Blue Shield Louisiana. "In the individual market, the risk pool is getting older on average, which means more people will need more health care services, and that drives up premium costs."

Blue Cross and Blue Shield Louisiana dominates the individual marketplace in addition to private employer-sponsored health plans across the state. Vantage Health, the other individual marketplace provider, is owned by Blue Cross and Blue Shield. Christus Health Plan joined the marketplace in 2020, but all of its plans are focused on the Shreveport, Lake Charles and Alexandria metro areas. 

Blue Cross and Blue Shield Louisiana increased its Blue Saver Individual plan premium by 10.8% while its Blue Max Individual plan increased by 7%, both effective this month.

For scope, a Blue Saver Blue Cross and Blue Shield Louisiana plan costs $582 each month for a hypothetical 27-year-old woman who does not smoke, according to the health care marketplace website. 

In general, monthly health insurance premiums through the individual marketplace ranged between $350 and $450, which is federal tax credits are applied that reduce the cost for policyholders based on their income. 

Deductibles, which is what customers pay out of pocket until insurance kicks in, were upward of $2,800 and yearly out-of-pocket maximums were around $8,000 for most plans. 

Between 2017 and 2021 premiums in Louisiana increased by 32%, according to an analysis by the Kaiser Family Foundation.

Even those who qualify for tax credits don't always see the insurance options as affordable, Nolan said. 

"The tax credit didn't keep pace with the increase in premiums," she said.

Email Kristen Mosbrucker at kmosbrucker@theadvocate.com.