Wyoming Leads Nation in Obamacare Price Jumps

With their Affordable Care Act insurance premium costs set to rise from the current rate of $600 a month to $3,000 starting next year, Elizabeth Aranow and her husband aren’t sure what to do.

“We haven’t purchased a plan yet, because I’m reeling from sticker shock,” Aranow said. The Lander residents could buy a cheaper marketplace plan, but at $1,800 a month, the least expensive plan available still more than doubles their costs while offering less coverage. The situation has spurred them to consider major life changes, like applying for new jobs with benefits or going without insurance.

But “to me, not having insurance is not an option,” she said. Aranow has experienced injuries that required surgeries in recent years.

Health policy changes, a shifting market and expiring tax credits mean the roughly 45,000 Wyomingites who get health insurance through the Affordable Care Act marketplace are experiencing the highest price jumps in the nation.

In Wyoming, a 60-year-old person earning roughly $63,000 is facing a 421% increase in average monthly premium costs on the ACA marketplace, according to reporting by KFF, a nonprofit that writes about health care. No other state equals or tops that percentage. The same individual would face increases of 231%, 166%, 192% and 134% if he or she lived in Montana, Colorado, Utah and Idaho, respectively.

“It’s pretty terrifying,” Eranow said.

Not all patients are experiencing such dramatic rises; costs depend on factors like age and annual income. But health care advocates worry that sticker shock will cause consumers to either find private plans with cheap price tags but lousy coverage or abandon insurance altogether.
“I think that we’re going to see a lot of people just not buy insurance and take the gamble that if something happens, they’ll be able to figure out how to pay it off through the hospital,” said Jenn Lowe, executive director of Healthy Wyoming, which advocates for affordable health care.

The consequences, Lowe thinks, will be more medical debt, more uncompensated care in hospitals, increasing insurance costs for everyone, rising health issues due to patients avoiding preventative care and higher stress — which also leads to worse health outcomes.

“All of this should be very concerning to health care consumers in the state,” she said. “Now that the expiring tax credits are coming and people are seeing in real time what the increase in costs are going to be, I think a little bit of reality is hitting that we have some of the most expensive [health] insurance in the nation.”

The How and Why

The Affordable Care Act marketplace, created in 2010, is available to people who don’t qualify for Medicaid and don’t have insurance through an employer.

In 2020, Congress created the Enhanced Premium Tax Credit during the COVID-19 pandemic to make marketplace insurance more affordable. That program provided subsidies that drastically reduced premium costs. For some low-income customers, monthly premiums went to $0.

The program helped contribute to an all-time low in America’s uninsured rate, health advocates say. But they were not cheap — and fiscal conservatives argued they were unsustainable. Congress extended the credits in 2022, but did not extend them again this year. A deadlock over the tax credits played a significant role in the recent government shutdown.

Expansion would have a $212 billion deficit impact on government spending over 10 years, according to a 2020 estimate from the Congressional Budget Office.

Ultimately, Congress struck a deal that did not include an extension. With the enrollment period opening Nov. 1, patients have only recently been able to log in to the system to see what their new plan options are. Open enrollment is the annual window when individuals and families can sign up for ACA health insurance, adjust plans or cancel coverage.
Insurance companies increased baseline plan costs this year. With the subsidy changes factored in, some became exponentially pricier. In addition, Mountain Health Co-op stopped offering health plans in Wyoming. That means the state is down to just two providers.

Lowe’s organization has been holding forums around the state this fall to help educate patients about the changes. The most recent one, held last week in Casper, had the biggest attendance so far. She attributed that to people actually seeing what their increases will be.

“I heard from people who are having to make decisions about paying for rent, paying for food and being able to pay for their insurance,” Lowe said. “It’s definitely kind of scary times.”

Navigating

The Lander Free Medical Clinic has also been hearing from patients it formerly helped set up with ACA plans. Audrey Zanetti, a medical assistant who supervises the clinic, brought up one who was on a $0 premium plan.

“It was going to auto-renew to a similar plan,” Zanetti said. Except that the new premium would have climbed from $0 to $650. That equates to about 40% of the person’s monthly income — and it doesn’t include co-pay and deductible costs.

“And so if that individual hadn’t come in, they would have been locked into that plan, it would have autorenewed,” she said. “They would have seen the bill come January or February, and would have said, ‘I can’t afford that.’ They would have cancelled the plan, and then not been eligible [to re-enroll] because they’re outside of open enrollment.”

Health insurance is complicated, and the auto-renewal caveat is not a detail everyone is aware of.

In the past, health “navigators” — trained professionals who guide customers through the open enrollment process — have been available largely thanks to federal funds. The U.S. Department of Health and Human Services slashed that funding by 90% this year.

As a result, Enroll Wyoming, which offered free help to those seeking insurance, cut its staff from 10 people to just one full-time and one part-time employee.
To make up for some of the loss, the program has established a statewide network of organizations with health counselor training.

“We wanted to set up a system where people could still get help,” said Enroll Wyoming Navigator Katelyn Befus. “We brought in the organizations and partners that we’ve been working with for years, and leaned on them a little bit to become certified.”

The Lander Free Medical Clinic is one of those places; VISTA Volunteer Stephanie Kohm recently completed the training. It is also holding free community sessions.

As Enroll Wyoming’s only full-time navigator, Befus is “extremely” busy, she said. “I’m literally completely booked for appointments all the way through the first half of enrollment. So that would be all the way through Dec. 15.”

Befus has heard some frustrations from customers about prices going up. She’s done a lot of explaining about how the tax credits were designed to sunset, she said, and people are generally understanding.

However, Befus said, households that earn over 400% of the federal poverty level — $62,600 for a one-person household — are getting hit hard.

“They’re looking at extremely high premiums,” she said, like in the neighborhood of $5,000 a month for a four-person household.

“So we’ve been having to recommend outside insurance to people over that 400% because for a lot of them, they just can’t afford that much money,” Befus said.

Guidelines and Deadlines

The deadline to enroll in an ACA marketplace plan starting Jan. 1 is Dec. 15. If customers enroll between Dec. 15 and the closing date of Jan. 15, coverage will start Feb. 1.

Experts urge people to be deliberate.

“I really encourage people to go to the [Healthcare.gov] website and use the ‘browse plans and prices’ tool to see what their expected tax credit and premium is before they jump in,” Befus said.

Those who do not want to continue ACA policies need to be careful they don’t auto-renew, she added. And for people exploring private insurance, she recommends calling insurance companies directly and fully understanding plan provisions before purchasing.

Befus stressed caution in shopping online. “There are a ton of fake and scammer websites out there,” Befus said.

A Different Solution?

Another thing people can do, Lowe said, is “Call your federal delegates and let them know that this is impacting you personally.”

In the tax credit stalemate this fall, Republicans were generally against extension while Democrats were in favor. Wyoming’s U.S. Sen. John Barrasso, a retired physician, told NBC’s Meet the Press that Obamacare is a failed measure and Republicans want to replace it with something that works to actually lower costs.
“I’ve always wanted people to get the care they need, from a doctor that they choose, at a price they can afford — and Obamacare basically destroyed that possibility,” Barrasso said. “We cannot just continue to subsidize a failing plan, which is causing more and more costs and hardship around the country.”

It’s easy to criticize Obamacare, Lowe said. What’s harder is coming up with a better solution.

“Republicans committed to talking about health care insurance once the government reopened,” she said. “Well, guess what? The government is reopened. Let’s talk about health care insurance. You guys don’t want the marketplace. How are you going to be able to provide health care insurance to the people of Wyoming?”

Health insurance, Lowe said, creates longer and healthier lives. “It’s a policy solution that we know works.”

Now is the time to hold delegates accountable, Lowe said. “And say: ‘if not this, then what?’”

This story first appeared in the Daily Montanan. Read the original WyoFile.