Thursday, November 1 marked the start of the 2019 health care open enrollment period for the nearly 11 million Americans who purchase individual health care coverage through either the federally operated healthcare.gov or a state health care exchange portal. Most Americans receiving coverage through their employers (56%) or the Medicaid and Medicare programs (36.5%), though efforts to repeal and replace the Affordable Care Act (ACA) have caused individual health coverage to remain in the spotlight over the past few years. Open enrollment for 2019 runs from November 1-December 15 in most states, with coverage beginning on January 1, 2019.
Late last year, both houses of Congress voted to repeal the ACA’s Individual Shared Responsibility Payment, as a part of the Tax Cuts and Jobs Act of 2017. The change, which takes effect this year, zeros out both the dollar amount and the percentage of income penalties imposed by the mandate on individuals who can afford health insurance but choose not to buy it. While states such as Massachusetts, New Jersey, and Vermont have chosen retain individual mandates penalties, most residents will have more health insurance coverage options for 2019, since they will not face a penalty for obtaining a health care plan that is not compliant with ACA guidelines.
Additionally, this past August, the Trump Administration released a final rule on new short-term health insurance policies, which went into effect on October 2. The rule makes three major changes:
- Extends the current short term plan duration from 90 days to up to 12 months
- Allows policies to be renewable for up to 3 years
- Requires short-term plan information to disclose how it is different from individual health insurance
These changes could have significant impacts on health coverage costs: the premiums for short term policies could cost half as much as comprehensive coverage. However, these plans also do not have to adhere to many of the ACA provisions, such as coverage for maternity care, prescription drugs or mental health care. The administration estimates that about 600,000 people will enroll in a short-term plan this year.
As a result of these changes and last year’s termination of cost sharing reduction (CSR) payments, it is expected that average premium rates will see a slight 4% increase this year due to a weakened marketplace. Every county in the U.S. currently has at least one insurer in the marketplace, and financial assistance for low-income consumers is still available.
Counties invest over $80 billion annually in community health systems and often serve as recourse payers for those unable to afford health care. In many states, counties are required to provide some health care for low-income, uninsured and underinsured residents. NACo supports expanding health coverage to help counties protect the health and wellbeing of their residents and will continue to monitor related legislative developments and their potential impact to counties.