New York state individual health rate increase requests for 2018 range from 4.4% to 47.3%. (Photo: Allison Bell/TA)

(Bloomberg) — Health insurers in New York state are seeking another year of hefty premium increases for their Affordable Care Act plans, adding fuel to the debate over the law’s future.

Insurers are seeking to boost their premiums 16.6% on average for 2018, the state Department of Financial Services said Wednesday. While that’s not as high as the 18% hike they requested last year, it’s still a substantial increase in cost for New Yorkers who don’t get help from Affordable Care Act premium tax credit subsidies.

(Related: Regulators Ask Washington to Save Health Market)

The companies are grappling with an uncertain future for the Affordable Care Act system as they craft their plans for next year, and rate increases have varied widely among states. Republicans in Congress are working to repeal portions of the health law, while President Donald Trump has called the health law a failure and raised doubts about whether he’d make ACA cost-sharing reduction subsidy payments to insurers. Meanwhile, major insurers, including Aetna Inc. and Humana Inc., have largely exited the health law’s markets.

In New York, 16 insurers submitted rate filings for NY State of Health, the state’s ACA exchange program, and the requested increases ranged from 4.4% to 47.3%, depending on the insurer. The state regulator can require the companies to adjust their requests. Last year, after adjustment, the regulator allowed for a 16.6% hike.

Blaming D.C.

New York state provided little information about what’s behind the increases. The insurers’ filings weren’t immediately available online. But insurers and regulators in other states have laid the blame for some of their premium increases on uncertainty from Washington. The key questions include whether the Trump administration will enforce the requirement, known as the individual mandate, that all people buy health insurance, and whether it’ll pay the subsidies.

The wide range across states and companies is a testament to the haziness of the market.

In Pennsylvania, for instance, the regulator required insurers to submit their rate requests assuming smooth sailing, leading to a relatively smaller 8.8% request. But if the mandate isn’t enforced and subsidies aren’t paid, Pennsylvania’s insurers said they’d need to boost rates 36.3%.

In North Carolina, the dominant BlueCross BlueShield plan is raising rates about 23%. But the insurer would have increased rates just 8.8% if it had certainty on the subsidies, which are known as cost-sharing reduction payments. In Maryland, Virginia and Connecticut, premiums will rise more than 20% on average, according to data compiled by ACASignups.net and Bloomberg.

CareConnect, a health insurer owned by Northwell Health, requested a 29.7% increase for individual plans in New York, saying the hike was “part of a continuing correction and is an unavoidable response to this population’s unexpectedly large and continuing need for medical care.”

— Read Blue Cross Carrier to End Iowa Individual Sales in 2018 on ThinkAdvisor.

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