Breaking Down the Current State of the ACA

October 20, 2017

Melissa Andel, MPP, director of health policy at Applied Policy outlined the most up to date policy changes that could impact how insurers participate in ACA marketplaces in 2018.

During her session at AMCP Nexus 2017, “Current Status of the Affordable Care Act,” Ms Andel outlined how the marketplaces are currently faring, how recent policy decisions by the Trump Administration will likely impact the market places, and the numerous legislative actions taken by congress in 2017 related to the ACA.

Ms Andel began her presentation by giving the audience a clear understanding of what the ACA marketplaces looks like today. She noted that the marketplace only covers 4% of Americans and suggested that marketplaces are not in as bad a shape as current media coverage suggests. She also highlighted that the real dysfunction is related more to health care access than it is health insurance coverage.

The ACA has had a positive impact on health insurance coverage in the United States, according to Ms Andel’s presentation, with 30 million Americans having gained insurance since its implementation, which reduced the uninsured rate to about 9%—the lowest in the country’s history.

She also emphasized that the financial outcome for insurers was beginning to look positive in 2017.

“Believe it or not, in 2017 insurer financial performance actually looked like it was beginning to stabilize,” Ms Andel said. She cited data showing that in 2017, average individual market gross margins per member per month increased from a steady plateau of about $45 between 2011 and 2016, to $99.43 in 2017.

Trump Administration’s Actions

Ms Andel gave a timeline of the recent actions taken by the Trump Administration that could significantly impact how the ACA functions.

“There is a series of actions by the Trump Administration that could—and I really do mean this—potentially undermine the marketplace enrollment and risk pools in 2018,” Ms Andel said.

However, Ms Andel stressed that plans are unlikely to really see any effects of these efforts in the short-term.

“Plans need to be prepared to deal with an uncertain situation for the forseeable future,” she said. “2018 is already planned and baked, we’re going to have to start preparing for 2019 in a couple of months—but I think it is going to be 2020 at the earliest before we start to see a fundamental change, if we do see a change at all.”

Ms Andel highlighted how the current Administration recently decreased funding for ACA enrollment outreach by 90%, advised HHS employs not to participate in state-based enrollment promotion, taken steps with the IRS to allow taxpayers to not answer questions regarding health insurance status, shortened open-enrollment, and added maintenance downtime of during the enrollment period.

However, the most talked about change by President Trump, according to Ms Andel, was the recent decision to stop reimbursing health insurers for their cost sharing reductions.

She explained that 57% of ACA enrollees receive cost-sharing reductions—a process through which insurance companies reduce costs for active health care users on a monthly basis and then reconcile those reductions with the federal government to receive reimbursement at the end of the month.

Article continues on page 2