With all the political upheaval over Obamacare this year, an already confusing process could be even trickier for thousands of Ohioans who soon will be shopping for health insurance through Affordable Care Act marketplaces.
The open enrollment period has been cut in half, and advertising and in-person help for people trying to pick an insurance plan has been drastically reduced.
Middle-income Ohio residents — those who make more than four times the federal poverty level, or $81,680 a year for a family of three — could suffer the brunt of insurance company rate increases under Obamacare, since those with lower incomes will receive government subsidies to cover the price jump.
While most Ohioans have health insurance through their employers or from government programs such as Medicare or Medicaid, about 207,000 bought individual plans through the Obamacare exchange.
"We recognize that people tend to procrastinate, and we’re going to be stressing: Don’t procrastinate," said Steven Wagner, executive director of the Universal Health Care Action Network of Ohio.
"I worry that people won’t know they need to get enrolled and that they’ll miss the deadline."
Dr. Mysheika Roberts, medical director for Columbus Public Health, said the agency is "pushing the message out" and will have counselors available from 11 a.m. to 3 p.m. Tuesdays and 9 a.m. to 1 p.m. Thursdays to help people get signed up. "You may not think you need it, but you never know when you are going to get sick, and we want people to access preventative care."
Open enrollment begins Wednesday and runs through Dec. 15 — about six weeks shorter than last year under changes made by President Donald Trump’s administration.
Those enrolling this year will face other hurdles that could further complicate the process: The Trump administration eliminated the advertising budget for the enrollment period, meaning fewer reminders that it’s time to enroll; the healthcare.gov site will be shut down for maintenance between midnight and noon on six of the seven Sundays during the enrollment period; and consumers will have less help choosing and signing up for the appropriate plan after sharp funding cuts for "navigators" who have aided thousands in signing up in recent years.
Those factors spurred Rep. Joyce Beatty, D-Jefferson Township, and the rest of the state’s Democratic House delegation to write a letter complaining to the administration. Beatty said Trump and his administration "continue to do everything in their power to destroy the Affordable Care Act."
If the enrollment hurdles aren’t enough, Ohio consumers also will have fewer choices for insurers and face higher premiums, according to the Ohio Department of Insurance.
In 2018, 42 of Ohio’s 88 counties will have only one insurer offering plans on the exchange, and 20 counties will have just two. This year, 20 counties had one insurer selling insurance and 27 counties had two.
The insurance department calculates that the average annual premium cost for individual plans sold on the federal exchange in Ohio will be $5,798.83 — about $483 a month. In 2017, the average annual cost was $4,786.48. That’s a 21 percent increase.
Karen Pollitz, a senior fellow at the nonpartisan Kaiser Family Foundation, said the decline in navigator funding, the drastic cuts in advertising and the shortened enrollment period "suggest depressed enrollment" for 2018.
She said that after Trump was sworn in, the federal government abruptly canceled all the TV ads encouraging people to enroll. As a result, she said, sign-ups dropped.
The 71 percent funding reduction for navigators — Ohio lost its only statewide navigator this year when the Ohio Association of Foodbanks left the program after funding cuts — might also depress enrollment, Pollitz said. Navigators, she said, "did a ton of outreach," canvassing libraries, grocery stores and other public spaces to alert people that it was time to enroll. In their absence, she said, "community health centers are going to have to pick up the slack as best as they can."
Navigators didn’t just do outreach; they helped people start applications. When dealing with young applicants, who didn’t have the necessary credit rating to sign up, they helped them figure out how to get the appropriate documentation to enroll. When they ran into people struggling to determine what their 2018 income would be, they helped them determine the best plan choices. And in Medicaid expansion states like Ohio, she said, they helped them get into that program.
"It was a whole broad range of activities navigators were required by law to engage in," she said. "And the loss of that one statewide program, I think, will be noticed."
Enrollees also should prepare for some "really strange rate increases" next year, Pollitz said. Insurers, expecting that the federal government would stop paying cost-sharing subsidies, passed those costs onto consumers.
The rates will go up in all plans, she said, but the silver plans have jumped 20 to 30 percent while the gold plans have increased at a slower pace.
Before silver plan enrollees decide to enroll in a different plan, Pollitz advises them to remember — for every penny more you pay in health care costs, so too does your tax credit go up for those eligible — namely, those making up to $81,860 a year for a family of three. More than 3 in 4 Ohioans with coverage through the Obamacare exchange received tax credits as of February, according to Kaiser.
"You may be surprised," Pollitz said, saying that with the tax credit, "you could find you can buy more with it this year than you could last year."
Wagner said, "There is a perception of unaffordability, that premium costs going up but people need to shop to see what their costs will be."