Price of many ACA health policies has dropped since last year

In recent years, some cities, including Memphis and Phoenix, have sunk into the desert of health insurance, while insurers have fled and premiums have soared in the insurance markets created under the Affordable Care Act.

But today, as in many parts of the United States, these two cities are experiencing an unprecedented experience: insurance premiums are falling and choices are increasing.

In the newly competitive Memphis market, for example, the cheapest mid-level "money" plan for 2019 will cost $ 498 per month for a 40-year-old man, a 17% drop from year-to-date. last.

And four insurers are currently selling ACA fonts in Phoenix. This is the same market that the presidential candidate, Donald Trump, had pointed out in 2016 because all but one insurer had left the region – he had called the evidence "the folly of Obamacare" .

Janice Johnson, a 63-year-old retiree from Arizona's Maricopa County, which includes Phoenix, said her monthly premium for a high-deductible bronze plan would be $ 207 for 2019, instead of $ 270, as she switches to carrier.

"When you have a fixed income, it makes a difference," said Johnson, who is receiving a government grant to cover his premium. "I'll know more in a year if I'm going to stay with this company, but I'm going to give them a chance, and I'm pretty excited about that."

In all 50 states, the "average" money plan premiums, which the government uses to set subsidies, fall by almost 1 percent. And more than half of the counties in the 39 states that depend on the federal HealthCare.gov fell on average 10% less for their cheapest plan.

In most places, declines are not enough to erase the price increases that have occurred since the creation of the Health Bursaries in 2014.

Instead, next year's price cuts help correct the huge increases set by insurers for 2018 to protect themselves from anticipated Republican attacks in the markets. While Congress only had one vote to repeal the federal health act in the summer of 2017, Trump and Republicans in Congress managed to eliminate many of the structural fundamentals that were driving people to buy plans and helped insurers pay for some of the co-payments and deductibles of income customers. Insurers responded with an average increase of 32% for 2018.

"Insurers were overwhelmed last year," said Chris Sloan, one of the directors of Avalere, a Washington, DC-based health care consulting firm. "We are not This market is still very expensive and has little benefit in terms of deductibles and cost. "

For 2019, the average premium for the benchmark cash plan will be 75% higher than in 2014, according to data from the Kaiser Family Foundation. (Kaiser Health News is an independent editorial program of the foundation.)

When Republicans failed to abolish the health law last year, they may have inadvertently strengthened it. Insurers have made significant profits in 2018, which has attracted new businesses to most ACA markets.

According to a federal government analysis, all of these factors were particularly influential in Tennessee, where the average benchmark premium fell by 26%. This is a bigger drop than in any other state.

78 of the 95 counties in Tennessee had only one insurer for 2018. This monopoly allowed the insurer to set prices for its projects without fear of competition, said David Anderson, researcher at Duke -Margolis Center for Health Policy in Durham, North Carolina. "They were very expensive," Anderson said of all available policies.

But for the coming year, 49 counties in Tennessee will have more than one insurer, with a few – like Shelby County, where Memphis is located – with four companies competing. There, Cigna dropped the price of its Silver plan by 15% at the lowest price. Even then, Cigna was under-purchased by Ambetter of Tennessee, a company owned by Centene Corp.'s health care insurer.

"We have finally come to the point where the market is stabilized," said Bobby Huffaker, CEO of American Exchange, a Tennessee-based insurance brokerage company. "From the beginning, every subscriber – [and] the people who were the architects – they knew that it would take several years for the market to ripen. "

Nevertheless, the cheapest Memphis cash bonus is nearly three times greater than that of 2014, the first year of the markets. A family of four, headed by 40-year-old parents, will pay $ 19,119 for the next year unless they can claim a government grant.

"The non-funded leave," said Sabrina Corlette, a professor at the Institute of Health Policy at Georgetown University. "They find these premiums unaffordable."

The landscape of Phoenix has improved dramatically since Trump's visit after the federal government announced an increase of 116% in premiums for 2017; the number of insurers was then increased from eight to one.

Now three new insurers are entering Maricopa County. Meanwhile, Ambetter, the only insurer to offer plans for 2018, has cut 12% of its lowest price for a cash plan for next year – and offers the cheapest plan in the market.

Nevertheless, Ambetter's plan is 114% higher than the cheapest money plan proposed in the first year of trading. And neither Ambetter nor any of the insurers entering the market for 2019 offer a choice of doctors and hospitals as broad and flexible as consumers had at the time, according to Michael Malasnik , a local broker.

Since the beginning of the exchanges, said Malasnik, the insurers have "increased their rates by multiples and they understood that you must be a very close network".

Each plan in Phoenix for 2019 involves compromises, he said. Only Bright Health's plan includes the Phoenix Children's Hospital. Ambetter's plan includes the most popular groups of hospitals and doctors, said Malasnik. But these providers are not as well located for people living in the southeast corner of the county, making other insurers' plans more appealing to some clients.

"Geography is the name of the game this year," Malasnik said.

Theresa Flood, a preschool teacher who lives outside of Phoenix, said that none of the dieters' benefit networks she considered included her doctors, such as the specialist who deals with her column problems spinal. She has undergone four surgeries and a neurologist who monitors a cyst and a benign tumor in her brain is also outside the network that she has finally chosen.

"I need to establish care with a brand new spine doctor and a brand new neurologist if I want to follow up on these issues," said 59-year-old Flood. who the hell am I going to see? "

The plan chosen by Flood would have been ultimately too expensive, except that she and her husband, John, minister, could claim a subsidy of $ 1,263 a month, which will bring the cost down to $ 207 a month. Ambetter's Bronze Plan includes a deductible of $ 6,550 per person; Flood therefore expects to pay for its own treatments and visits to the doctor, unless it needs extensive medical care.

"It has become impossible to have a plan that you could afford and which you had an advantage, to support what you can afford and hoping that nothing requires you to use your insurance," he said. she said. "At this point, I'll take what I can have."

Kaiser Health News, a non-profit news service, is an independent editorial program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente.