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Volume XXIX
Winter 2017

Outlook

No Immediate Changes Expected for the Affordable Care Act

by Connie McMullen

Heather Korbulic
Heather Korbulic, Executive Director of the Silver State Health Insurance Exchange.

With the Republican administration ready to take control of the White House, the first item on the agenda is repeal of the Affordable Care Act, better known as Obamacare. Repeal of the ACA will potentially affect an estimated $29.8 Million Americans.

Heather Korbulic, Executive Director of the Silver State Health Insurance Exchange says the ACA will not go away anytime soon. "Right now we are working on Open Enrollment through January 31, 2017. But with all the rhetoric around the politics of ACA, things are going to obviously change."

And change is what is being discussed on Capitol Hill. Republicans plan to submit legislation to repeal Obamacare next year and delay the effective date to allow time to pass a replacement to the ACA.

"The exchange is working on how they can advise and be a part of health care reform whatever happens with the new administration," said Korbulic. "We have been paying close attention to the changes that potentially can happen. We want our consumers and clients to know it takes time to make changes such as this. It took four years to implement the ACA and longer to pass it. So all the bills that have been put forth are seen as potential avenues the new administration would use."

A budget reconciliation is expected in early January 2017 to repeal the ACA. "What that does is eliminate the budget pieces associated with it, the subsidies. In those bills it offers a two year transition period. It gives the new administration a two year window to legislate, pass and implement a new replacement of the ACA."

Action to repeal the ACA has the heath care industry concerned. Hospitals, ensurers and actuaries have been telling the administration and Congress that repeal of the 2010 law will have consequences that would create a ripple effect, costing them billions to unwind what has been put in place over the past six years.

"There are certainly parts of the ACA that have not been successful, like the cost of high premiums," Korbulic said. "It's important for Nevada consumers to know that the national average of premiums went up 25 percent but here in Nevada it is closer to 10 percent. So we're looking at a much less increase in costs for 2017."

Eighty-seven percent of the population that purchases insurance through the state health exchange are eligible for federal subsidies, and when premium costs go up the federal subsidy goes up.

federal subsidy goes up. "It will be a small impact to a person's budget and wallet," Korbulic said. "The budgetary reconciliation bill repeals those subsidies, but the subsidies will still be in place until they find a replacement plan."

Korbulic says the new administration has been clear that they do not want to just unplug the ACA, and leave people out in the cold without insurance. "They still want to ensure all of those that are currently being served and who have insurance through the exchange or through expanded Medicaid keep their insurance. We're just waiting to see what kind of policies will be put forward."

Nevada's health insurance exchange no longer has the problems it did the first year of operation, and this year there have been less delays when accessing health coverage. The Nevada Silver State Health Insurance Exchange enrolled 88,145 people last year and is hoping to increase that number.

A glitch that could affect enrollment next year is in the platform used. A rule comes out every year from the Center for Medicare and Medicaid Services (CMS) that tells the exchanges operating as a state-based marketplace who use the federal platform, how much it is going to cost to use Healthcare.gov. "They told us we will pay 1.5 percent of premiums in 2017. It is a high cost, but it is a tolerable cost. For 2018, CMS has said the fee will be 3 percent which is going to be almost the entire health exchanges budget."

Korbulic says they are negotiating with CMS to try to drive those prices down, or at least keep the 2018 costs at 1.5 percent so they can maintain stability in the marketplace while looking at other opportunities to transition to an existing technology platform that will be significantly less in costs.

With enrollment so high, many consumers have been voicing their concerns. "We're hearing from consumers who have had pre-existing conditions that they are afraid that they will not be able to purchase insurance in the next few years. That is one area the ACA has been a success. You can come in with a pre-existing condition and get the same community rate as anybody else with or without an illness."

Korbulic says they try to set minds at ease by telling consumers that the President-Elect has indicated he does like that component of the ACA and hopes to maintain and continue the pre-existing condition clause. The other thing consumers like is the clause that allows their children to stay on their plan until the age of 26, another component the President- Elect has said he likes as well.

"It is such an uncertain time. Until an actual policy is put forward, it is not worth our time to have anxiety over what will or will not happen. There is always a chance the ACA will not be repealed but modified."