Enrollment in Nevada’s new state-run health care exchange dropped by just over 6,000 for 2020, news that comes amid a hectic few weeks for the health care discussion nationally.
“It’s likely it had to do with the same reasons as in years past — uncertainty,” said Heather Korbulic, executive director of the Silver State Health Insurance Exchange. “There are the same kind of political headwinds. There’s uncertainty and confusion.”
A total of 77,410 Nevadans selected exchange plans during the open-enrollment period, which ended Dec. 15 but included a five-day extension to Dec. 20 for individuals who’d started the application process before the deadline. Total enrollment reached 83,449 for 2019.
Nevada transitioned 65,563 enrolled individuals from the national platform to the new platform in its first year returning as a state-run exchange. The state in recent years enrolled clients through the federal government’s Healthcare.gov platform.
The average approved rate increase on the state exchange was 1.6 percent, which Korbulic described as relatively stable.
The state exchange will work to ensure a large number of individuals who recently sought insurance from Medicaid but do not qualify are aware of the options on the exchange, Korbulic said.
The exchange will also look into its data to determine who did return and if individuals who’ve previously obtained exchange insurance chose cheaper, less-comprehensive options like short-term health insurance for 2020 as restrictions on those options have been loosened by the Trump administration.
Nationally, the Centers for Medicare and Medicaid Services described U.S. enrollment as “stable,” despite technical issues that resulted in a two-day extension of the enrollment period.
This year’s enrollment period came amid the Trump administration’s ongoing efforts to weaken the ACA, Democratic presidential candidates debating the future of health care in the country, and a headline-making court ruling.
Last week, an appeals court sided with a federal district court judge in ruling the Affordable Care Act’s individual mandate unconstitutional and sent the case back to him. The judge will now be expected to conduct a more detailed appraisal of what that means for the rest of the Affordable Care Act.
The Texas judge originally ruled that striking the individual mandate meant the entire law was invalid.
Nevada was one of the states that intervened in the suit in defense of the ACA after the judge’s ruling last December.
The uncertainty surrounding the law’s fate has created confusion among the general public, who’ve been hit with waves of news concerning the Affordable Care Act and its exchanges since the law’s inception.
Yeraldin Deavila, spokeswoman for the Nevada Division of Insurance, said the division doesn’t expect a final decision on the validity of the law until after the 2020 elections.
“Until then, the Division continues to regulate the health insurance industry according (to) the ACA,” she said. “The Division has not received many comments from consumers, other than some expressions of hope that the prohibition on pre-existing condition exclusions survives the challenge.”
Bradley Herring, associate professor of health policy and management in the Johns Hopkins Bloomberg School of Public Health, pointed out that a 2017 Republican tax law already effectively eliminated the individual mandate’s associated tax penalty for those who did not purchase insurance in 2019.
The elimination of the individual mandate by a court then likely wouldn’t have much effect on enrollment signups on the exchanges for 2020, he argued. He added that the tax penalty was never as big of an incentive to sign up for insurance nationally as the tax credits and cost-sharing reductions aimed largely at low-income individuals.
Those credits can be applied up-front to lower the cost of exchange tax plans for those who qualify.
For instance, Nevada Health Link’s “estimate my costs” tool suggests than a single, 30-year-old individual who doesn’t smoke earning $30,000 a year and living in the 89154 ZIP code would be eligible for tax credits of roughly $102/month as well as other potential savings. But those estimated credits and savings shrink as that individual’s salary approaches $37,000.
Herring explained that many of the individuals who often cannot afford exchange plans are those who make too much for subsidies and do not have employer-provided insurance. That group represents a small proportion of the overall population.
About 5 percent of Nevadans were covered by a policy purchased directly from an insurance company in 2018, as opposed to about 48 percent of Nevadans who said they had employer-based coverage, according to data estimates by The Henry J. Kaiser Family Foundation.
Eventually, the Affordable Care Act and the issues that go along with it will likely make their way to the Supreme Court, said Edwin Park, a research professor at the Center for Children and Families within the Health Policy Institute at Georgetown University.
Park argued President Donald Trump’s administration is to blame for recent increases in the uninsured rate nationally and said he doesn’t believe most Americans are aware of the Affordable Care Act’s reach.
The law didn’t just create exchanges, greatly expand Medicaid, enforce protections for those with pre-existing conditions and allow young adults to stay on their parents’ insurance.
It also made fundamental changes to the way health care works in the United States, from affecting Medicare prescription drug coverage to extending Medicaid coverage to former foster youth, he said.
“If you overturn the entire Affordable Care Act,” he said, “it includes numerous provisions that include all aspects of the health care system.”