More than 12 million Americans – including 143,577 Louisianans – bought health coverage in 2017 through the Affordable Care Act’s (ACA) health insurance marketplace. But as the Nov. 1 start of the 2018 open enrollment period looms, the future of that coverage remains uncertain due to President Donald Trump’s repeated efforts to undermine the federal health reform law.  

The president’s sabotage has led to double-digit premium increases in many markets by reducing federal payments to insurance companies that help keep costs low for consumers. The Trump administration also has reduced funding for outreach and enrollment, which helps people understand their coverage options and pick a plan that best suits their needs.

Congress has an excellent opportunity to mitigate the damage by taking up legislation co-sponsored by a bipartisan group of 12 Democrats and 12 Republicans, including Louisiana’s Bill Cassidy. The “Alexander-Murray” bill, named for its chief sponsors, would ensure federal payments are made to insurers through 2019 and reinstate funding that supports outreach and enrollment. The bipartisan plan would also allow increased flexibility to states to alter the ACA’s requirements under certain conditions.

What’s more, the Congressional Budget Office found the plan would save the federal government $3.8 billion over the next decade.

Louisiana’s health insurance marketplace

The vast majority of Louisiana residents enrolled in health insurance marketplace plans (86 percent) earn below 400 percent of the federal poverty line ($98,400/year for a family of four) and receive federal tax subsidies to cover a portion of their premiums. Those who earn above 400 percent of the poverty line can still buy plans on the marketplace but do not receive subsidies. The amount of subsidy each enrollee receives varies based on the actual cost of their health insurance plan premium and their income. If premiums increase, consumers who receive federal subsidies are insulated from the price increase, because the subsidy level automatically adjusts to account for the price increase.

More than half of marketplace enrollees in Louisiana (55 percent) also benefit from federal cost-sharing reduction payments, or CSRs. Insurance companies that sell plans through the marketplace exchange are required to reduce deductibles and copayments for consumers with incomes below 250 percent of the federal poverty line ($60,750/year for a family of four). The ACA stipulates that insurers are entitled to reimbursement for the costs of providing cost-sharing reductions to those who qualify. In 2016, Louisiana consumers benefitted from $185 million in total cost-share reduction payments.

The administrative disruption in the individual market is affecting older Louisianans. More than a quarter (28 percent) of Louisiana’s marketplace enrollees are older than 55, and 56 percent are women.

Undermining the health insurance marketplaces

The Trump administration has taken five major actions that have undermined the future stability of the health insurance marketplaces and jeopardized the coverage:

  1. Reduced funding for outreach and education by 90 percent.
  2. Reduced federal funding for enrollment assistance by 40 percent. In Louisiana, the cut to enrollment assisters, known as Navigators, was a whopping 80 percent.
  3. Cut the open enrollment period during which consumers can buy an insurance plan on the health insurance marketplaces from 90 days to 45 days, and shutting the website down for “maintenance” until noon on most Sundays.
  4. Ended cost sharing reduction payments to marketplace insurers beginning November 2017, which led Louisiana insurers to increase premiums by up to 30 percent.
  5. Signed an executive order directing federal agencies to explore the expansion of “association health plans” and “short-term” health plans that could allow cheaper, skimpier health plans to compete with ACA marketplace plans.

An analysis by Get America Covered estimates that the cuts to ACA outreach and education alone will reduce marketplace enrollment by 1.1 million people in 2018. Reduced enrollment will result in a smaller risk pool, greater instability in the marketplaces and even higher premiums.

Despite the broad support in the Senate, President Trump has flip-flopped on his support for the bipartisan agreement and House Republicans have expressed little interest in considering it. Most recently, House Speaker Paul Ryan said the House will not take up health care legislation again in 2017. Their inability to support a compromise that will both save the government money and protect vulnerable consumers is yet another example of partisan politics interfering with good health policy.