How Obamacare premium hikes affect politics and your wallet

The new enrollment period for the Affordable Care Act is about to begin and there are some changes in both price -- double-digit percentage increases for premiums on average -- and choice. Judy Woodruff learns more from Mary Agnes Carey of Kaiser Health News and Reid Wilson of The Hill, and gets the perspectives of people around the country who are weighing their options.

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    And late today, The Washington Post reported that the Trump campaign has ended its joint fund-raising with the Republican Party. That could hurt the party's get-out-the-vote efforts.

    And as we just heard, the state and fate of the health insurance law, or Obamacare, is front and center today. That's because, as the new enrollment season for coverage is about to begin, the administration announced that premiums will rise by 25 percent on average for a benchmark mid-level plan through the federally run market.

    At the same time, choices are decreasing. One in five consumers will have a single insurer to choose from. It's not a simple picture. Federal subsidies for most people getting coverage this way will increase.

    To help us understand more about it, and how this all plays into the campaign, I'm joined by two following this closely. Mary Agnes Carey covers the marketplace for Kaiser Health News, and Reid Wilson covering the politics of it for The Hill newspaper.

    We welcome you both.

    So, Mary Agnes, to you first.

    How many people are affected by this? What percent of the population overall?

  • MARY AGNES CAREY, Kaiser Health News:

    Of all the people who buy health insurance, 5 percent buy on the ACA exchanges. Most of us get our coverage either through work or through the Medicaid program or the Medicare program.

    So it's about 20 million people on the individual market. About two-thirds of those get marketplace plans. It's important to them, of course, but you have to look at it in perspective with the overall numbers.


    And these are people who live across the country?


    Across the country, all 50 states. The federal government sells — of the health insurance exchange, there are plans are in about 38 states, and rest and the District of Columbia are state-run plans.


    And the range of — the percentage of increase differs from state to state?


    All over the place.

    For example, in Arizona, you had 116 percent increase in premiums, monthly premiums, $196 to $422. And we should say these are before the subsidies kick in. And these are premiums for a 27-year-old male. So we have to look at it from that perspective.

    Nebraska, we're talking about a 51 percent increase. Ohio, a 2 percent increase. Massachusetts, actually a 3 percent decrease. So it's really depending on where you live. If you live in an urban area or a rural area, that's also going to affect the number of providers and the networks and that sort of thing.


    So, Reid, as we see, this is already having an effect on the presidential campaign. We heard Donald Trump a few minutes ago saying this is the end of Obamacare.

  • REID WILSON, The Hill:

    And it's played a role in Republican campaigns who are running for Senate and House seats around the country.

    In New Hampshire, Senator Kelly Ayotte is already up with an ad attacking Governor Maggie Hassan, one of the most watched Senate races in the country, over Governor Hassan's support for the Affordable Care Act.

    What's notable, though, is that the amount of advertising specifically around the Affordable Care Act is actually down significantly from earlier years. It's almost as if public opinion on this matter has been baked in for the last five years — or six years really since it's been debated. And there aren't that many people who are willing to change their minds.


    So, just because I know it's complicated, Mary Agnes, but why has this happened?


    Well, it's happened for a variety of reasons.

    Insurers may have gotten in early and underpriced their products to try to get more market share. And now they are going to have to even that out. We may have had — likely have had a lot of sicker people get in first. Everyone sort of knew that when they did the Affordable Care Act. The sickest people come first. They are the most expensive people.

    You also have an ability of some plans manage costs better than other plans. And so now we're going to hear more about these things called narrow networks and other tightening of costs. And also some federal programs to help insurers balance out the cost of these really sick people, two of them are going away next year, and the other hasn't necessarily worked as intended, so it's sort of a combined effect.

    And different factors have a different effect depending on where you live.


    So we talked to several people around the country affected by these rate increases.

    Let's begin with a woman named Beth Plein. She lives in Maryland.


    My name is Beth Plein. I'm 64. And I live in Cockeysville, Maryland.

    I am one of the small number of people who self-insures and doesn't qualify for a subsidy, so my insurance premiums are very high, bordering on the unaffordable. I have actually tracked my insurance even in the years before the Affordable Care Act, and they were rising gradually, but after 2014, they were spiking dramatically.

    I started with a $548 premium. So I changed the plan, went down to a $411 premium with a higher deductible. And then next year, I don't know what it will be. I can't change it again, because this is the least expensive plan.

    I don't know what can be done because it's such a complex issue. At this point, you have to depend on the government to iron it out. So, hopefully, that's what they will do.


    Mary Agnes, how typical is she?


    Well, we're hearing more and more from these people who don't qualify for a subsidy. It's roughly in the ballpark of five to seven million people who are buying on the individual market or in the exchanges. They don't qualify for a subsidy.

    And it's really difficult, because while many people, something like 85 percent, of individuals on the exchange can get that subsidy that can help lower the premium, there are folks that don't have that.

    And I received an e-mail this week from a small business person who said he felt like he had absolutely no hope for the Affordable Care Act for him to be able to afford the premiums. And, of course, we have this requirement for coverage.


    And, Reid, we just heard her say, she said, I wish — she says it's now up to the federal government to fix it. But what's the likelihood that that can happen?


    Well, the question really depends on what happens in November, two weeks from now, on Election Day.

    If Hillary Clinton wins the presidency, Democrats win the Senate, and Democrats win the House, well, there's a real good shot that the Democrats will do something to repair the Affordable Care Act on a wholesale basis.

    But taking back the House is a really steep hurdle for Democrats, and we have seen Republicans in control of the House vote to repeal the Affordable Care Act 50-plus times. This is — the Republicans in the House have been unwilling to even make technical corrections to the bill.

    So, unless there is some massive sea change within the Republican Party, which I don't see happening, it's going to be very difficult for even the smallest corrections to be made.


    So, we also talked to a single mother with two children in Greensboro, North Carolina. This is one of the states where so many insurers have pulled out.


    My name is Natalie Cunningham. I'm 30 years old. And I live in Greensboro, North Carolina.

    I have Coventry health insurance, where I pay just $9 a month. And the subsidy on it is $237. I recently found out that my insurer, Coventry, was not going to be part of the marketplace, Obamacare, anymore. And so now I'm at the point of, you know, OK, now I'm going to be switching to Blue Cross/Blue Shield, but whether I will be able to afford it, because I don't know how much the plans are going to go up, and they had already just about doubled at the end of 2015.

    Just going by what I can handle, because when you want to pick between buying school shoes or, you know, paying extra money into the health insurance plan, as a mother, sometimes, you have got to make those decisions and cut out the health insurance.


    Mary Agnes, why are so many insurers pulling out?


    Well, sometimes, they just didn't make the money that they wanted to make or they have had a hard time managing the sicker folks who have come in initially, and trying balance out the risk pool.

    But what's really interesting I think about this example is that it illustrates states where insurers are leaving the market causing some problems. She's from North Carolina. In about — about 230,000 people in North Carolina are going to have a change with their plan because two or three insurers are dropping out.

    Alabama and South Carolina, there's one insurer statewide. But one word of encouragement, if I could offer, is that her subsidy is going to increase as the plans increase in price. You mentioned this in your introduction.




    For that benchmark plan, that will also increase. So, she may find it not as unmanageable as she thinks.

    And, of course, for all of these consumers, getting on, or your state-based exchange to shop, you might be able to go to a plan in that same category, whether it's a silver or a bronze or gold or a platinum, and you might find something at a lower price that still works for you.


    And that's just going to take some time for them to figure it out.




    So, finally, let's hear — this is a young woman who lives in Brooklyn. She happens to be healthy. She's looking for an affordable policy.


    I'm Laura Brickman. I'm a 27-year-old who lives in Brooklyn, New York. I'm working as a freelance journalist doing video and print work.

    But, because it's freelance, I don't have an insurance plan through my employer. So, I'm currently uninsured. To me to buy a plan is a little bit frustrating, because I feel that I don't use it personally, and the amount of money I would be spending on insurance is things that I could divert to non-health care issues, because I honestly don't have many health care expenses.

    And so the chances of me really taking advantage of the plan are very low, I think. I don't have any chronic health issues. The only thing I would use medical care for at this point is like a major medical emergency, which has not happened, fortunately.


    So, Mary Agnes, this reminds us these tough choices for young people like her who know they do have to pay a fine if they're not in the system.



    That's really important to remember. For next year, it's $695, or 2.5 percent of income, whichever is greater. And you have got to remember, even if you think, I can afford to pay that, you still don't have health insurance, and you're going to be on the hook if something happens to you.

    So there are some things that she can consider. There's a catastrophic plan for people under 30. There are some other options. Again, you should really go to the marketplace and check it out to see if something works.


    So, Reid, just finally, before we wrap this up, talk about what it is that Hillary Clinton and Donald Trump have said they want to do to either fix or adjust the Affordable Care Act.


    Well, neither have offered a lot of specifics on the matter. Donald Trump has talked about allowing insurance plans to be purchased across state lines, which has been a staple of the Republican policy for quite a long time.

    Hillary Clinton, on the other hand, has talked about the positive aspects of the Affordable Care Act, being able to stay on your parents' insurance plan until you're 26, some of the other positives that are broadly favorable, broadly popular across the country.

    But what's clear is that the next president is going to have to deal with some kind of fix for the Affordable Care Act. The question is what will they be able to get through what is likely to be a divided Congress.


    But the idea of unwinding it completely, which is what Donald Trump talks about, how practical?


    That — just like Republicans going along with changes to the Affordable Care Act is unlikely for a Democratic president, unwinding the Affordable Care Act is going to be very unlikely for a Republican president, whether it Donald Trump or whoever comes next, because there is a significant Democratic presence in the Senate, and they're able to block that.


    Well, this is a subject we have been talking about from the beginning of this campaign until right down to the end.

    Reid Wilson, Mary Agnes Carey, thank you both.



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