This is shaping up to be the most expensive year so far for Georgia consumers, like Shela Bryan, who buy individual insurance policies. Blue Cross Blue Shield of Georgia, the only insurer offering plans throughout the state, received approval for an increase of more than 21 percent from the state insurance commissioner. Humana was awarded a 67.5 percent hike.
The individual insurance market is for people who don’t receive insurance through their employer. About 10 million Americans buy such plans on the Affordable Care Act’s online marketplace, or exchange, and receive federal tax credits that help to reduce their costs. Roughly the same number acquire such plans — either on or off the exchange — but do not receive tax credits.
“For those receiving subsidies, the subsidy protects them against the increase. If they’re not eligible, they’ll be paying a lot more. And the more premiums go up, the higher the cliff,” said William Custer, a health policy and insurance expert at Georgia State University.
Bob Laszewski, a health policy strategist in Washington, said the Obama administration and health care advocates need to listen to the complaints of those who do not receive subsidies.
“These people are invisible,” Laszewski said. The ACA “is working very well for lower-income people, but the Obamacare supporters missed the fact that if you’re raising a family of four on $100,000, you’re not rich. This is the … guy who remodeled your house, who drives a pickup truck and he’s wearing a Trump hat.”
Double-digit increases are rattling other states, too. BlueCross BlueShield of Tennessee was granted a 62 percent rate hike and Cigna, 46 percent. Florida authorities approved an average 19 percent bump. And last week, Minnesota officials announced that premiums are rising 50 to 67 percent.
The insurers are now adjusting for some miscalculations, said Graham Thompson, executive director of the Georgia Association of Health Plans. “The prices are up this year, but our hope is that things will settle down after this year,” he said.
Insurers facing ‘sicker shock’
While consumers face sticker shock, the insurers have faced what might be called “sicker shock,” which has sent their prices spiraling. That is, they’ve found that customers on the individual market are sicker and more costly to cover than expected when the Affordable Care Act took effect.
Federal and Georgia officials note that customers can change plans each year to find a better price, but that also can result in higher deductibles and may force a change in doctors.
Bryan, who makes just over the limit for a subsidy, finds herself in that market now.
“I’ve worked … all my life,” said Bryan, a maintenance supervisor who does not receive insurance through her employer. “We’re the ones entitled to something, because we’ve worked. They tear me up in taxes and then they say my income is too high for a subsidy?”
She could end up paying as much as $14,000 in premiums for a pared-back policy the likes of which she had never imagined, she said, with no coverage for her asthma and blood-pressure medications. The cheapest policies amount to more than a quarter of her yearly income, or double her mortgage, she noted.
That total package would increase her premiums $4,400 over what she is paying for her COBRA plan and raise her deductibles by $5,800, for a possible increase in costs of $10,200. And that was based on 2016 premium prices.
For a state struggling with how to extend coverage to nearly 1.4 million uninsured, the added frustration, anger and fear of rising premiums complicates Georgia’s already complex health care landscape. Nevertheless, Georgia’s rate of uninsured has declined from 22 percent (2012) to 13.9 percent (2015) since Obamacare provisions took effect.
‘These people are invisible’
Elena Hamilton of Dunwoody has seen her premiums nearly double in the first three years under the Affordable Care Act. She does not receive a premium subsidy and is afraid of what she will find when the exchanges open Nov. 1. And she, unlike Bryan, isn’t looking until she has to.
“Under this program with Obama, things just keep going up and up and up. People who own small businesses are hurt, the middle class is hurt,” said Hamilton.
Bryan said she feels like she is paying for other people’s subsidies with her high premium.
But Linda Blumberg, a senior fellow at the Urban Institute, explained that the subsidies do not work that way.
“It is not the people paying full premiums who are paying for the lower-income person,” she said. Federal dollars are already allocated for that.
The federal Department of Health and Human Services announced Tuesday that as many as 95,000 people who buy insurance off the exchange in Georgia and 2.5 million nationally may be eligible for a subsidy and not know it.