TALLAHASSEE — Republican efforts to repeal the Affordable Care Act may be dead for now, but the fight over health care is far from over and the uncertainty could lead to higher insurance costs in Florida and across the country.
Despite the failure of the repeal bill July 27, President Donald Trump can still take action that would undercut the federal health care law known as Obamacare. Trump threatened to remove subsidies for policies bought on federal- and state-run exchanges set up by Obamacare.
“If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” Trump tweeted after the bill failed.
The Trump administration “has been very clear: they want to see Obamacare implode,” said Mark Pafford, former Democratic state House member and a board member of Florida Chain, a health-care access advocacy group. “So can they do that? Absolutely. They can defund it; they can destabilize it.”
Trump has already killed funding for groups in Orlando and other cities that have helped people sign up on the exchanges.
Supporters of the law think it’s already having an effect on the insurance market.
“President Trump sowing uncertainty by threatening these ACA payments is hurting people,’’ said Meaghan Smith, a spokeswoman for the Protect Our Care Coalition, a group dedicated to preserving Obamacare. “This sabotage could force people’s premiums up by double digits, forcing millions of middle-class Americans to pay more and costing people their coverage. Make no mistake, this is a Trump Tax on people’s health care premiums,”
Trump and other Republicans, though, argue Obamacare is imploding anyway and will eventually fail with or without federal payments for plans on the exchanges. They point to projected increases in premiums nationwide and fewer insurers offering exchange plans.
Gov. Rick Scott, a longtime critic of Obamacare who may be considering a run for the Senate next year, wants Congress to repeal the law, but a spokesman wouldn’t say whether he thought Trump should withdraw the subsidies.
“If more government was the answer, health-care costs should have been dropping and if this Congress can’t stop these astronomical increases in health care costs, then the Governor believes we have the wrong Congress.” Scott spokesman John Tupps said in an emailed statement.
In Florida, the number of insurers offering exchange plans fell from 10 in 2015 to six in the current year. Average premiums have increased by double digits in the state in the past two years.
Still, the removal of subsidies would have a massive impact on Florida, which has more than 1. 5 million people getting coverage through an exchange, the most of any state. More than 1.4 million of them receive federal subsidies.
The cost of the plans and the amount of the subsidies vary by type of plan, region of the state, age and income, but the average monthly premium for a Silver Plan for a 40-year-old non-smoker with an annual income of $30,000 is $306, with an average subsidy of $99, according to the Kaiser Foundation, a nonprofit that tracks health care policy.
Eliminating subsidies would price many out of the exchange market. Those likely to retain coverage would be sicker patients most in need of care. That would prompt health insurers to increase rates — above the hikes already projected under the current law.
Regulators and health insurers are already bracing for the possible removal of the federal subsidies by Trump.
“Obviously the uncertainty in the marketplace for the insurance companies has a direct correlation on rates,” said Audrey Brown, president of the Florida Association of Health Plans, a trade group for health insurers. “It’s our hope that there’s some certainty that happens before the next cycle begins in January, because right now everyone is basically trying to have Plan A [and] Plan B in place, because of the unknown.”
Nine companies in June filed rate increases with regulators based on the current law, with subsidies averaging 17.8 percent. Six of those companies – Blue Cross & Blue Shield of Florida, Celtic Insurance Company, Florida Health Care Plan, Health First Commercial Plans, Health Options and Molina Healthcare of Florida – offer individual plans on the federal exchange.
The rates, some of which have not yet been approved by regulators, would take effect Jan. 1, 2018.
The Florida Office of Insurance Regulation also asked insurers to submit contingency rates based on the potential elimination of subsidies by the Trump administration. They are not yet publicly available.
A Kaiser estimate from April projected a 25 percent increase in premiums if the subsidies were eliminated.
In addition to administrative action, Trump has another way to eliminate subsidies. An ongoing lawsuit from the U.S. House, brought during the Obama administration, seeks to remove the payments. Trump could decide not to contest the lawsuit.
The outpouring from supporters of the law and progressive activists, who pressured lawmakers at town halls across the country, has given some advocates hope that the electorate is realizing the benefits of Obamacare and will keep it in place, despite the GOP wins in 2016 after promising to repeal the law.
“Hopefully we’ll see more people coming out and talking about how this supposed failure of a program that’s going to implode actually did something good,” Pafford said.
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