Days before the 2018 open enrollment period begins, an independent health policy consulting firm released a report on Wednesday about the state of premiums on the health exchanges created by the Affordable Care Act (ACA), otherwise known as Obamacare.
It found that premiums for silver plans -- the most popular on the exchanges -- will rise by 34 percent in 2018. By comparison, premiums rose 25 percent this year from the year before.
Avalere Health partially attributes the hike to continued uncertainty at the federal level over the ACA. Less than two weeks ago, President Trump eliminated cost-sharing reduction (CSR) payments, which make insurance more affordable for low-income consumers. That move, critics say, will limit the number of insurers willing to sell plans on the exchanges and lower the number of people who can enroll in them.
Also on Wednesday, a judge rejected states' emergency request to reinstate the CSR payments.
The biggest hikes will be in Iowa, Wyoming and Utah, at 69 percent, 65 percent and 64 percent, respectively. Anticipating steep rate hikes, Iowa asked to waive certain aspects of Obamacare but withdrew their request this week once it became clear that it would be rejected by the Trump administration.
In three states, though, premiums are actually going down. In Alaska, by 22 percent; in Arizona, by 6 percent; and in North Dakota, by 4 percent.
Alaska’s relatively dramatic decrease is attributed to its reinsurance program, which the federal government approved earlier this year. Under a reinsurance program, government -- state, federal or a combination -- pays for the sickest and costliest patients, lowering costs for insurers and consumers.
Governors from both sides of the aisle have pressed Congress to help fund their own reinsurance programs, but bipartisan discussions to stabilize the health marketplace have failed. Trump told Congress this week to focus on reforming tax policy, not health care.
The non-stop turbulence on the federal level has left state officials and insurers with little clarity this year.
“It’s an unstable market. It’s messy and confusing, and we’ve got no help at the federal level,” says Mike Rhoades, Oklahoma’s deputy insurance commissioner.
Oklahoma’s premiums are rising only marginally -- 6 percent -- compared to 76 percent last year, the highest in the country. But Rhoades says it’s still been a tough year for the state’s marketplace. State officials submitted a waiver request earlier this year to establish their own reinsurance program, but it ended up withdrawing it.
Most people who shop on the Obamacare marketplace receive subsidies to help pay their premiums. But health experts say there are still millions of people who don’t qualify and who will be more likely to opt out of health coverage.
Since Trump took office in January, Obamacare has proved to be the most heated topic, spurring fights between and within the parties.
"The public has become very callous to the whole situation," says Denise Burke, senior policy and planning analyst for the Department of Insurance in Wyoming, which has just one insurer committed to staying in the marketplace.
The open enrollment period kicks off Nov. 1.