Obamacare sign-ups projected to rise slightly

ACA facts

The fourth year of open enrollment in private health insurance plans offered under the Affordable Care Act starts Tuesday, and officials expect 13.8 million consumers in Ohio and other states to sign up for coverage that takes effect in 2017.

That would be an increase of 1.1 million over the 12.7 million who signed up for so-called Obamacare plans during open enrollment in 2016 — including 34,876 in the nine-county Miami Valley region, and more than 243,000 Ohioans overall.

The projections are well below initial government forecasts of 24 million Obamacare enrollees by 2017, leading critics to suggest that lower-than-expected enrollment is evidence that Americans are rejecting the health care law.

While Republicans and Democrats alike agree that Obamacare is far from an unqualified success, lower enrollment numbers are largely the result of positive trends in the labor market.

Initial government projections included more than 10 million people who were expected to be kicked off their job-based insurance plans as employers took advantage of Obamacare to shed health costs and dump workers into state and federal health insurance marketplaces, or online exchanges, to buy government-sponsored health coverage.

Projections also assumed many full-time workers would see their hours and health benefits cut in response to the law’s “employer shared responsibility” provision, which requires businesses with 50 or more full-time employees to provide health insurance or pay a fine.

But according to the U.S. Bureau of Labor Statistics, the number of people working part-time because they couldn’t find full-time work or had their hours cut fell by 17 percent from about 7.1 million Americans in September 2014 — the first year of coverage under the health care law — to 5.9 million this September.

And the percentage of firms offering health benefits to at least some of their employees has increased slightly, from 55 percent in 2014 to 56 percent this year, according to the Kaiser Family Foundation.

“The job market is very competitive right now with unemployment hovering around 5 percent, so it’s very hard for employers to cut benefits or not offer health insurance to attract and retain employees,” said John Bowblis, an economics professor Miami University.

“But if we go into another recession, and the job market becomes less competitive, it could be possible that employers cut benefits because they can shift those costs onto the exchanges.”

Both major presidential candidates have been critical of Obamacare. Republican Donald Trump vows to “repeal and replace” the law while Democrat Hillary Clinton is calling for fixes to ensure the law’s long-term sustainability.

According to the U.S. Department of Health and Human Services (HHS), average premiums for the most popular “silver” plans sold on federally run Obamacare exchanges in 38 states, including Ohio, are expected to rise 25 percent next year. And the number of marketplace insurers will drop by 28 percent — from 232 to 167 — as a number of big-name carriers retreated from the exchanges because they were losing money.

In Ohio, the number of insurers will drop from 17 to 11 next year, but some rural and less-populated counties will see their options cut even further.

“We are down to one insurance company,” said Randy Gaerke of Mercer County. “I am looking at $16,000 per year plus (in premiums), and deductibles over $6,000. There are many people in Mercer County in the same position. Small businesses, farmers, etc., are getting hammered.”

Gaerke was referring to the approximately 37,000 Ohio marketplace consumers who don’t qualify for income-based premium tax credit subsidies that hold down costs for about 85 percent of marketplace shoppers nationwide.

In addition to paying the full cost of their premiums out of pocket, people without subsidies are facing substantial increases in their deductibles, according to Kevin Coleman, head of research and data at HealthPocket.com, a health insurance cost-comparison website.

Compared to this year’s average of $5,731, the 2017 average “bronze” plan deductible for individuals will climb 6 percent to $6,092. The 2017 “silver” plan average deductible for individuals, $3,572, is about 15 percent higher than the 2016 average.

“With respect to 2017, it is immediately evident that the market conditions facing the unsubsidized are getting considerably worse,” Coleman said. “The percentage increase in average premium for each category of Obamacare nationwide is in the double-digits.

“And deductibles among bronze and silver plans, the plans more likely to be purchased by people without subsidies, are still considerably beyond what the average family has saved for medical bills.”

The non-subsidized rates in Ohio are expected to rise only at about half the rate as the national average, and Ohio is one of only a handful of states with more than 10 providers in its health exchange, creating competition that keeps prices in check.

At least 51 percent of Ohio marketplace consumers with subsidized coverage will be able to find a plan with a premium of less than $75 per month, and 60 percent will be able to find plans with premiums below $100, according to a recent HHS report.