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ACA Uncertainty Puts Enrollment Caps in Spotlight

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The New York Department of Financial Services on July 6 said that no insurer participating in the state’s Affordable Care Act health insurance exchange will cap the number of people who enroll for coverage, as insurers offering plans on other state health exchanges across the country have done.

New York’s contracts with insurers in its exchange, New York State of Health, do not allow enrollment caps, according to the state’s Department of Health.

(Related: ACA Exchanges Report Strong Early Application Activity)

“It requires insurers to sell policies to all individuals that the marketplace determines eligible to purchase health insurance during open enrollment, or a special enrollment period,” the health department said in an emailed statement.

As uncertainty over the future of the Affordable Care Act looms, insurers across the country are looking to cap enrollment in an effort to stabilize their finances.

Health Partners, based in Bloomington, Minnesota, and Medica and UCare in Minnesota capped their enrollment this year. In Kansas, Medica also put a cap on the plan offered through the marketplace. Community Health Choice, one of only three insurers offering plans in Houston, saw a spike in enrollment from 40,000 two years ago, to roughly 145,000, according to Modern Healthcare, a trade publication. The plan’s executive vice president and chief operating officer told the publication that the insurer can’t handle many more enrollees.

In mid-May, the state noted in a report that more than 3.6 million people were enrolled through the state’s health exchange under the Affordable Care Act at the end of the 2017 open enrollment period, an increase of roughly 800,000 since the third open enrollment period.

But the state also said that the number of people who bought Affordable Care Act plans in the commercial marketplace declined. According to the report, 242,880 people enrolled in a private health insurance plan through the online marketplace created by the Affordable Care Act, down 11% from the year before.

Health insurance exchange plans have had a rocky last few months due to increasing premiums, some plans’ high deductibles and the disdain of the Trump administration and the Republican Congress for the Affordable Care Act that created them.

Across the country, several counties could be left without any options for subsidized insurance coverage.

In Iowa, Medica, which has threatened to leave the health exchange, is the sole insurer for 94 of 99 counties. Health insurance giant Anthem has announced plans to leave Ohio’s marketplace in 2018, and will also pull out of the markets in Wisconsin and Indiana, citing the uncertainty surrounding the future of the Affordable Care Act, and whether the federal government will continue to pay cost-sharing reductions to insurers.

The Centers for Medicare and Medicaid Services projects that several counties in Nevada, Missouri, Indiana and Ohio will have no health-exchange insurers in the upcoming year.

— Read 10 ACA Exchanges With Upmarket Appeal on ThinkAdvisor.


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