The launch of the Affordable Care Act’s open enrollment Monday will test whether more generous financial assistance to consumers helps President Biden reach his goal of boosting coverage by building on the health law.
Many consumers will see lower prices because Congress passed a $1.9 trillion coronavirus-aid bill in March that provided larger premium subsidies and made more people eligible for them. Democrats are now negotiating to preserve the expanded subsidies, which are set to end next year, in Mr. Biden’s social-spending and climate bill.
Sixty-seven percent of enrollees who stay with the same type of plan they had in 2021 will pay $10 or less a month in 2022 after the increased subsidies, according to federal officials. Open enrollment runs from Nov. 1 through Jan. 15 in the 36 states that use the federal exchange.
The low-price plans are a result in part of the relief legislation that provided zero-dollar premiums to people with incomes between 100% and 150% of the federal poverty level, which is an income of about $12,800 to more than $19,000 for a single person. Consumers can also use subsidies for the lowest-priced plans sold on the exchanges. Lower-priced plans can come with higher out-of-pocket costs, but shoppers may also be eligible for subsidies to lower those expenses.
“You pay less than $10 for a cup of coffee a week,” said Health and Human Services Secretary Xavier Becerra in an interview. “It’s a fantastic deal. There are more plans, and the good thing is there are more insurers coming in so there are more choices.”
Republicans say the health law has driven up costs and stripped decision-making away from states, and that the new subsidies don’t help matters.
“House Democrats have also proposed making their poorly targeted Obamacare premium subsidy hike permanent,” GOP Sen. Mike Crapo of Idaho said at an Oct. 20 hearing on health-insurance coverage. “This proposal does nothing to improve Obamacare plans or to address the underlying healthcare costs. The administration has also taken a series of steps that risk constraining consumer choices, delaying or weakening coverage, and undermining innovation.”
Consumers can go to HealthCare.gov to compare plan options and find out if they are eligible for financial assistance, which can help pay monthly premiums and reduce out-of-pocket costs when receiving services. They generally need to choose a plan by Dec. 15 for their coverage to start Jan. 1.
More than 12 million people were in ACA health plans as of mid-September, a record high. About 10% of adults ages 19 to 64 were uninsured during the first half of 2021, according to a report by the Commonwealth Fund, a nonprofit research organization that supports expanding healthcare.
This open-enrollment season will bring a number of changes aimed at bolstering the ACA after efforts by the Trump administration to weaken the law.
The Biden administration says it will launch one of the largest outreach campaigns to date, with increased sign-up help available at no cost to consumers. The Centers for Medicare and Medicaid Services has awarded $80 million in grants for the 2022 plan year to navigators, who assist people in obtaining ACA-compliant coverage, as well as providing them almost $11.5 million in additional funding.
That more than reverses cuts made by the Trump administration, which reduced outreach funding for 2019 open enrollment to $10 million from $36 million in 2018 and almost $63 million in 2017.
“It really is different,” said David Blumenthal, president of the Commonwealth Fund. “It will be easier than ever before, it’ll be more affordable, and people will have more time than ever before.”
The administration extended the open-enrollment period by an additional month, giving people more time to shop for plans. Consumers will also have more choices because more insurers are selling plans on the ACA exchanges and expanding their service areas.
There will be 213 insurers offering coverage through HealthCare.gov, an increase of 32 issuers compared with the 2021 plan year, federal officials said. Eighteen states now have more issuers participating in the 2022 plan year than the 2021 plan year. The average consumer will be able to choose from between six and seven insurance companies, up from four to five companies in 2021, officials said.
Costs will also be lower for many health-plan shoppers. For a 27-year old, premiums for one of the most popular medium-price plans will be 3% lower than last year, according to a CMS report.
The coronavirus rescue legislation in March eliminated an income cap that limited who was eligible for ACA subsidies to reduce monthly insurance premiums. It also limited the amount that households pay on healthcare to 8.5% of their income and boosted subsidies to lower-income consumers.
Democrats say the growth in ACA enrollment underscores the need to extend the legislative changes rather than letting the larger subsidies expire. Lawmakers are looking at a possible three-year extension.
The rescue legislation provided zero-dollar premiums to people with incomes between 100% and 150% of the federal poverty level after subsidies. The subsidies are also known as tax credits and have been a boon to consumers, some lawmakers say.
“Nearly two out of three consumers can get a plan with zero premium, after tax credits. Extending those improvements, in my view, is a no-brainer,” Democratic Sen. Ron Wyden of Oregon said at the October hearing.
A Democratic proposal to increase subsidies for low-income people and expand eligibility would increase federal deficits by $209.5 billion over the 2022-2031 period, according to a September estimate by the Congressional Budget Office. That has drawn criticism from Republicans.
“It’s money we don’t have,” said Sen. John Barrasso (R., Wyo.). “They haven’t figured out how to pay for this.”
Consumers in states operating their own marketplace platform can also enroll in a 2022 plan starting on Nov. 1. Fifteen states run their own exchange marketplaces, according to data from the Kaiser Family Foundation. More than 2.8 million consumers enrolled in marketplace plans during the 2021 special-enrollment window.
The lower premiums and record number of consumers enrolled in ACA plans have come despite lawsuits that sought unsuccessfully to overturn it and a failed Republican repeal effort in 2017.
“There have been a lot of changes to the ACA, administratively and legislatively, as the Democrats have taken over,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. Open enrollment, he said, “will be a test of their abilities to resurrect the ACA.”
Fifty-eight percent of adults had a favorable view of the ACA in an October poll by the Kaiser foundation, up slightly from 55% of adults in October 2020. Forty-one percent had an unfavorable view.