Sticker Shock: Is the Affordable Care Act Truly Affordable? 

"I would be surprised if insurance premiums were going down. Yes, I expect there to be some increases, but I can't tell you from who or how much."

The Affordable Care Act remains the most contentious debate of the 2016 political season. While each of the Republican party's top presidential contenders promise to pull the plug on Obamacare on their first day in office, even Democratic presidential candidate Sen. Bernie Sanders says it doesn't go nearly far enough. Only Hillary Clinton defends the status quo.

As most of the men who hope to take over the Oval Office would put the ACA on life support, more Americans—Idahoans in particular—are securing health coverage through marketplaces required by the law. What's more, the Gem State was second in the nation for per capita enrollments this year—only Florida was higher.

"We had 102,353 Idahoans select a plan in the enrollment period which just closed," said Pat Kelly, executive director of Your Health Idaho, which helps Idahoans search for and find insurance plans. "About a third of that number were people new to the Idaho exchange."

While there's reason to applaud Idaho's participation in the Your Health Idaho marketplace, what isn't discussed—at least publicly—is the sticker shock many of the newly insured will face if they use their health care plan. Of the 86 individual market plans offered on the Idaho exchange and approved by the Idaho Department of Exchange, a stunning 37 percent have deductibles of $5,000 or higher and out of pocket maximums are well north of $10,000, making the "affordable" part of the ACA an oxymoron.

"You might want to talk to the Department of Insurance about that," said Kelly, when asked about the high deductibles.

He's right. Pointing the finger at Your Health Idaho for high deductibles or out of pocket expenses is a bit like blaming the grocer for the price of milk.

"I agree that those are very high deductibles," said Idaho Department of Insurance Product Bureau Chief Wes Trexler. "But it's not necessarily a new trend. Prior to 2014, there were a good many individual plans with those high deductibles."

Right again. The Kaiser Family Foundation confirms deductibles have risen more than six times faster than wages since 2010. Here's the difference an increasing number of Americans will realize in 2016: The penalties for not securing insurance have skyrocketed this year. In 2014, eligible individuals who did not have insurance either through an employer or Obamacare faced a $95 fine. In 2015, it rose to $325. Now, in 2016, the fine for not having insurance is $695 or 2.5 percent of income, whichever is higher. Parents will have to pay an extra $347 per uninsured child. The penalty will continue to rise as it will be adjusted for inflation in 2017.

At Your Health Idaho, Kelly said his colleagues focus less on those penalties and more on the affordability and access to premiums versus the state-managed marketplace.

"For example, we look at a benchmark plan, a so-called 'silver' plan for a single person making about $25,000 a year. We compare 2015 to 2016, and we see that the same plan, less tax credits, changed by about $1."

As for the political noise swirling around Obamacare—GOP presidential hopefuls are falling over one another in their criticism of the plan—Kelly walks a tight, nonpartisan line.

"It's clear that people are talking a lot about the Affordable Care Act," Kelly said. "I certainly listen to that, but we know that the more we improve the consumer experience and focus on sustainability, then at least that noise will be a bit quieter for us. It's very clear that the Legislature and the governor wants the federal government to stay out of Idaho. We have local control and, by the way, everyone benefits from a healthy citizenry."

Kelly is more inclined to point out Your Health Idaho is on a path of self-sufficiency. For example, last year's operating budget, which was fueled in large part by assessment fees paid by Idaho insurance companies, was approximately $9.7 million and next year's budget is expected to be closer to $9 million.

"Idaho insurance carriers paid a 1.99 percent assessment fee on premiums this year. For a $300 premium, for example, that would be about $6," said Kelly, who anticipates the 2017 assessment fees to remain the same when his fiscal year 2017 budget is crafted in late March. "We're still working on that budget, but we're not contemplating a change at this point."

Meanwhile, at the Department of Insurance, Trexler is the man who must scrutinize any health insurance rate increases proposed by Idaho insurance companies. For example, this past year, Blue Cross of Idaho proposed an average 23 percent rate increase as did Mountain Health Co-Op. SelectHealth wanted a 15 percent increase and Regence BlueShield proposed a 10 percent increase.

"It's my job to see if those proposals are valid," said Trexler.

For the better part of May through July, he analyzes the insurance companies' details in their rate increase requests.

"If they provide sufficient justification, we accept the rate increase as submitted or we tell them to revise it"

Trexler said "averages can be deceiving" but in two cases last year, the DOI pushed down two proposed average rate increases (for BlueCross and SelectHealth), while approving a 10 percent rate increase for Regence BlueShield. In one instance, DOI even approved more than asked for: Mountain Health proposed a 25 percent increase; DOI approved a 26 percent hike.

"I wish I could tell the future. I can't," Trexler said. "But in general, medical costs aren't going down. So, I would be surprised if insurance premiums were going down. Yes, I expect there to be some increases, but I can't tell you from who or how much."

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