The costs of a good health plan can feel crushed without subsidies

Like millions of Americans in this last week of open-label listings of the Affordable Care Act, Diane McCabe is shopping for health insurance.

"At my age, I can not get through it, even if healthy now," says McCabe. She is 62 years old and is an independent real estate agent in Luzerne County, Pennsylvania. "But the process is frustrating and the expense is considerable."

This is because McCabe is one of the 5 million people who buy their own cover out of the ACA market) and pay the full cost. His income is too high to qualify for a government grant that would help cover the cost of the premium.

This week, McCabe opted for a $ 773 per month policy with a deductible of $ 4,000 – the amount she will have to pay. she estimates that this will represent at least 15% of her income in 2019.

Under the ACA, people who earn up to 400% of the poverty line (about $ 48,500 for an individual and USD 100,400 for a family of four in 2019) are eligible for bonuses. Eighty-seven percent of the 10.6 million people benefiting from ACA plans this year have received a grant.

The financial challenge faced by people like McCabe has been much more focused over the past year, due to rising insurance premiums.

Increasing costs, deductibles, and royalties have caused millions of people without subsidies to abandon their coverage or turn to less expensive, less comprehensive, and sometimes inadequate insurance.

The Trump administration has highlighted the fate of non-funded and said its regulatory reform of the health act will provide consumers with new, more affordable options.

One of the main efforts of the administration is to expand the use of short-term insurance plans. who have lower premiums but do not offer all the benefits required by the ACA, such as continued coverage of pre-existing illnesses or maternity care.

Governments are not eligible for subsidies at this time, but, under the regulation proposed by the administration in October, subsidies may be available from 2020.

Critics say that Approach of the administration is likely to undermine the essential features of ACA. And a legal battle around the new rules proposed by the administration is likely.

"The grant structure is unquestionably a problem," says Chris Sloan, director of Avalere Health, a think-tank on policy and research in Washington, DC "It's a cruel reality." for those who are above the income thresholds, but it is not clear that the actions of the administration are the best solution. "

Opponents of the proposals of the administration Trump claim that they could get young and healthy people to give up ACA coverage and choose less comprehensive and more expensive coverage. – leave more elderly and sick people in the exchanges. This would lead to a steady rise in the costs of these plans and could potentially destabilize ACA markets, say analysts.

Overall, about 4.4 million fewer people underwriting coverage are insured in 2018 compared to 2015, down from 2015. 18.8 to 14.4 million. Most of the decline was observed among people who do not receive subsidies.

Punctual Insurances

Cameron and Lori Llewellyn, of Dover, Delaware, claim to have found insurance too expensive.

In June 2017, Lori left a job offering the family a good health coverage. She wanted to start her own business – a clothing store. Cameron is an independent construction contractor.

The Llewellyn attempted to enroll in a scheme via the ACA exchange in the summer of 2017. But Cameron's income was too high to qualify for a grant. On the open market, they had quotation rates of up to $ 2,000 a month, with deductibles of $ 4,000 or more, for themselves and their 8-year-old daughter, Bryce.

They chose instead to stay without coverage until the end of the year. 2017. Again, for this year, they did not qualify for grants and decided to dispense with insurance.

"We simply could not justify the expense, especially with such a high deductible," said Lori. "But it was not a comfortable situation.We wanted coverage for all the reasons why people know that they need it."

For 2019, the Llewellyn try again. They registered through the ACA exchange of states in a policy providing a premium of $ 1,286 and a deductible of $ 7,900, but with a subsidy covering the entire premium.

Spencer Ricks, 36, a lawyer in Salt Lake City, United States. choose a different path. He, his wife, and their 3-year-old daughter bought an ACA-compliant hedge in 2016. Their premium increased from about $ 600 in 2016 to $ 970 in 2017, with a $ 10,000 deductible .

He was informed of his bonus for 2018 for 2018. Plan would be $ 1,200 with a deductible of $ 13,500. He disconnected the family coverage and instead enrolled his wife – who was pregnant – into a $ 570-a-month plan with a $ 5,000 deductible.

Ricks and his daughter, at the time joined a Christian Health Ministry program costing $ 157 a month, with a $ 10,000 deductible . For 2019, Ricks enrolled the entire family is another religion-affiliated scheme that offers more restricted coverage than those sold on the ACA Scholarship; it costs $ 529 per month and includes a deductible of $ 2,250.

But for 2019, the most prevalent alternative to an ACA scheme for people who do not receive grants is probably a short-term plan.

Previously available for the Trump administration extended this period to 364 days, essentially 90 days –

Plans can be purchased at any time, but sales are up now as more people make their purchases During ACA's open registration period, Sean Malia, Senior Director at eHealth, an online brokerage firm.

Melanie and Pete Howell, of Austin, Texas, are new to eHealth. They had an ACA plan this year costing $ 1,100 per month with a $ 7,000 deductible. She was covering the couple and their two children aged 22 and 17.

Howells' income is too high to qualify for a grant. When their insurer told them that the premium was going to rise to $ 1,400 a month in 2019, they opted for a short-term plan that will cost $ 380 a month with a $ 12,500 deductible.

The diet does not cover prescription drugs. The Howells will cover 30% of the costs associated with doctor visits, emergencies and any surgery.

"It saves us a much more affordable price to determine what needs to be done in the long run," Melanie Howell said. .

No Easy Solutions

Although critics and advocates of ACA say that tackling the high cost of coverage for families unsubsidized should be a priority, there is no easy solution of bipartisan solutions in sight.

Many supporters of ACA are calling for the adoption of legislation that raises the threshold of subsidies exceeding 400% of poverty – up to 600%, for example. But this raises the concern of additional federal spending.

A more realistic approach, for the moment, could be to allow states to experiment with ways to help people exceeding the threshold of 400%, Sabrina Corlette, professor-researcher at the Institute of Health Policy at Georgetown University.

For example, with the approval of the federal government, eight states have already launched or will launch in 2019 "reinsurance" programs that redeploy federal funds to help insurers cover their costs. costs of families with high medical expenses. The programs made it possible to limit the cost of premiums for beneficiaries and subsidized

. Another proposal would allow states to have greater flexibility to restructure ACA grants to provide less support to those who require very expensive health care and more. help those who are not currently eligible for grants.

"Leaving the States to the test, has bipartite support," says Corlette, "and there are already mechanisms in place for that, which seems to offer the best chance of bringing something useful to help this. population [the unsubsidized] for the moment. "

Steven Findlay is a journalist from Washington, DC, who writes on health policy and medicine. Kaiser Health News a nonprofit news service, is an independent editorial program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente.