Friday, November 17, 2017

Obamacare fact vs. fiction: What you need to know before open enrollment


Consumers are struggling to separate fact from fiction as the open enrollment period approaches for health insurance plans sold on the Affordable Care Act’s federal exchange, advocates and insurance companies say.

The controversial health care law lives on, even as the Trump administration and Republicans in Congress look for ways to kill it. Obamacare will continue to be the way millions of Americans sign up for coverage next year, and Wednesday is the first day they can enroll.

But experts say the political debate has produced misinformation that is confusing to the people who need it most.

"There’s new information each week in the news about potential changes," said Melanie Hall, executive director of the Family Health Care Foundation in Tampa, one of the government-funded nonprofits that helps people navigate the system and sign up for coverage on the exchange.

PREVIOUS COVERAGE: Uncertainty over Obamacare’s future sends premiums up, budgets down

The spread of false information about the ACA’s status and health care in general "has been going on for eight months," said Jodi Ray, director of the University of South Florida’s navigator program, Florida Covering Kids & Families. "People are calling us because they don’t understand if they’re losing their ability to get health insurance, and it’s up to us to articulate what they’re hearing in the news and what kind of effect that’ll have on them."


Advocates say these are the most common myths surrounding the Affordable Care Act, and they want to debunk them before open enrollment begins:

Myth No. 1: Obamacare is dead.

What surprises Ray the most is the large number of consumers who think the Affordable Care Act no longer exists. Officials with other navigator programs agree that this is the most common call they get.

"It’s really unfortunate that we’ve made so much progress on getting the word out and informing people in the beginning, and now we’re doing it all over again," Ray said. "The public education piece was so substantial in year one (of the ACA). We made significant strides. Now we need to get back out there."

The future of the ACA is up in the air as lawmakers continue to propose legislation that could alter or end Obamacare. Most recently, a bipartisan effort in the U.S. Senate proposed some changes but would keep the law mostly intact to help poorer Americans pay for health insurance.

While that bill is still alive, nothing has changed going into the enrollment period. Insurance companies are still offering plans on the federal exchange for 2018.

In past years, the government paid to market Obamacare on television and in other media, alerting consumers to changes and the open enrollment period. That’s not the case this year.

Large budget cuts, some up to 90 percent, have drastically reduced federal programs to get the word out. At the local level, navigators are preparing to do more with less in anticipation of the open enrollment period in Florida.

Florida Covering Kids & Families took a 15 percent cut to its budget this year, which comes to almost $900,000, Ray said. The Epilepsy Foundation of Florida, another statewide navigator based in Miami, shuttered earlier this month when its contract wasn’t initially renewed. It reopened a few weeks later with a new contract, but with a budget that was cut by 58 percent or nearly $1 million.

"It’s a very grass roots effort to get the word out since our budgets have been cut. We’ve been very proactive about reaching out to consumers whom we’ve previously helped enroll to let them know about the (enrollment) window and scheduling appointments," said Islara Souto, statewide program director of the Epilepsy Foundation. "Since we have this personal connection, we hope that it makes a difference. You can sense the anxiety in their voice."

Myth No. 2: Obamacare prices have gone up so much, no one can afford them.

Health insurance premiums are expected to rise an average of 45 percent in Florida next year, according to the state Office of Insurance regulation. An analysis by the Kaiser Family Foundation says the increases will range from 7 to 38 percent for "silver" plans, which are considered the standard in the marketplace and the most common choice of consumers who shop there.

Whatever the number, individual plans will not necessarily spike sharply, says Hall at the Family Health Care Foundation.

"The second-most-asked question we hear is, ‘Will I be able to afford it next year?’" she said.

Consumers are still eligible for the usual tax credits for premiums, and in some cases, those credits might be more than in previous years.

"What’s important to remember is that tax credits go up proportionally with premiums. So if they could afford the plan this year, they can afford it next year," Hall said.

One problem is the lack of information in advance of the enrollment period. Ray said navigators haven’t seen the plans and the various changes in cost — details that were available much earlier in previous years.

"We’re probably going to see an increase in costs. We’re getting pretty anxious because nothing has come out yet though," she said. "Usually we have seen them by this time of year already."

Myth No. 3: The tax credits I received before have been wiped away.

Earlier this month, President Trump ended the federal government’s payments to insurance companies for cost-sharing reductions, the subsidies that lower the amount some people pay for deductibles, copayments, and coinsurance. The subsidies mostly aided people with silver plans. But insurers had been anticipating Trump’s action for months, said David Pizzo, the Florida Blue market president for the West Coast region, which is why insurance prices are rising next year.

Those most affected are about 7 percent of the 1 million Florida Blue consumers with silver plans, or about 66,000 people, Pizzo said. This is also why the company is offering a dozen new plans outside of the Obamacare exchange that will be similar in price and coverage to the exchange’s silver plans from previous years. Florida Blue is honoring the cost-sharing reduction prices through the end of this year.

And, again, many consumers will likely see a bump in tax credits to shield them from premium hikes.

"The biggest myth is this perception that subsidies are gone," Pizzo said. "There are two different types of subsidies: premium tax credits, which are oftentimes called a premium subsidy, and the cost-sharing reductions, which is a whole different type. The generic use of ‘subsidy" is the problem."

Myth No. 4: The deadline to enroll is the same as last year.

Open enrollment for the federal exchange begins Nov. 1 and runs through Dec. 15. Some people in Florida could be eligible for an extension to Dec. 31 if they have been directly impacted by the recent slew of hurricanes, Harvey, Irma and Maria. The 2018 enrollment period — the fifth since the marketplace began in 2013 — is the shortest it’s ever been. The period is half the length of last year.

"What we worry about this year is that more people will wait until the last minute," Hall said. "I’m concerned they’ll be left out if we don’t get the message out that the hard and fast deadline is Dec. 15 this year."

To help jump-start the enrollment process, Hall says enrollees should sign into their exchange accounts online and make sure their personal information is updated and correct. If they need assistance, they should look up a navigator program on or and make an appointment as soon as possible.

Also, navigator programs are planning to hold extended hours in the evenings and on weekends in public places through partnerships with city and county governments.

The takeaways

To review, here are the points that experts are making in response to myths they hear from consumers:

• Obamacare continues to operate, and people can use it to buy health insurance for 2018.

• Insurance premiums are going up for next year, but Obamacare’s tax credits will continue to shield many consumers from those increases.

• The enrollment period, which starts Wednesday, is a lot shorter this year.

Contact Justine Griffin at or (727) 893-8467. Follow @SunBizGriffin.

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