27 and on Obamacare? Get ready to pay, and pay, and pay

Byron Lewis, health benefits navigator for North Country HealthCare, shows a spreadsheet comparing Affordable Care Act insurance premiums and tax credits from 2016 and 2017. Rates are expected to increase 25 percent on average and as much as 116 percent in Arizona.

Photo by Hubble Ray Smith.

Byron Lewis, health benefits navigator for North Country HealthCare, shows a spreadsheet comparing Affordable Care Act insurance premiums and tax credits from 2016 and 2017. Rates are expected to increase 25 percent on average and as much as 116 percent in Arizona.

KINGMAN – The political winds are blowing fiercely in favor of those who want to repeal and replace the Affordable Care Act as health insurance companies drop out like flies and monthly premiums are set to double in Arizona.

The Department of Health and Human Services confirmed that monthly premiums for ACA benchmark plans are going up in 2017 by an average of 25 percent in 39 states that participate in the federal marketplace.

In Arizona, a 27-year-old adult will see premiums for the benchmark silver plan rise by an average of 116 percent. Other plans will increase 50 percent to 75 percent.

About one of every five consumers is limited to a sole provider, which is Blue Cross Blue Shield of Arizona in 13 of the state’s 15 counties.

The numbers paint a grim picture for Arizonans facing open enrollment in ACA, or ObamaCare, which started Tuesday and runs through Jan. 31. You have to enroll by Dec. 15 for coverage starting Jan. 1, 2017.

Although premiums are increasing, nearly nine out of 10 Northern Arizonans qualify for financial help in the form of tax credits and cost sharing, cushioning the rate hike for many, said Byron Lewis, health benefits navigator for North Country HealthCare.

Federal officials estimate that tax credits could bring plans under $75 a month for the lower-income bracket of 336,000 eligible consumers throughout Arizona, and some may pay nothing.

“Premiums are going up, but tax credits are going up as well, so it’s not all bad news,” Lewis said during a stop in Kingman. “Some people will see an increase, but it’s like 39 cents. Others may take more of a hit.”

For example, a 27-year-old making 400 percent of the federal poverty level, or $47,520, will see benchmark premiums spike from $214.27 a month to $529.91 next year. However, they’ll get a tax credit of $147.37 in 2017, compared with zero in 2016. Still, they’ll be paying $382.54 a month for health insurance, or $168.27 more than this year. That’s a 78 percent increase.

Overall, if you make 250 percent of the federal poverty level or under, you’ll see an increase of less than $2 a month, Lewis said.

And while 13 counties were reduced to one carrier, that’s no different than what’s offered at workplace open enrollment, he added.

“In all fairness, this thing is evolving,” Lewis said. “What we saw in 2014 was not what we saw in the first enrollment period. You can start with the web site (www.healthcare.gov).”

The good thing about ObamaCare, Lewis added, is that it doesn’t preclude any pre-existing conditions, and there are no caps for insurance coverage. Women are on the same “playing field” as men, he said.

There are four main questions that apply to rates in the marketplace: how old are you; where do you live; what’s your income; and do you use tobacco.

FINDING A PLAN

Jeff Stelnik, senior vice president of Blue Cross Blue Shield of Arizona, said his company is trying to help Kingman residents better understand their health insurance options and changes. There were multiple insurers in the Arizona marketplace in 2014, and now there’s just one.

United Healthcare, Humana, Cigna, Health Choice and Phoenix Health Plan have all left the Arizona marketplace after taking losses. About 125,000 consumers will receive cancellation letters from current providers with their available options, or option.

Blue Cross Blue Shield of Arizona lost $185 million in the first two years of ObamaCare, but remains committed to insuring residents of rural counties such as Mohave, Coconino and Apache, Stelnik said.

“We believe changes are needed to ensure the long-term success of the program, including education of the public about one, the need for health insurance before they get sick, and two, the subsidies that are available to them in 2017,” he said in a telephone interview from Phoenix.

Blue Cross will offer up to five different individual and family plans under the Affordable Care Act, including EverydayHealth, Portfolio and SimpleHealth. To find the right plan, Arizonans should consult with a broker or go to coveraz.org.

Members who enroll in Blue Cross Blue Shield plans must use their primary care provider to coordinate their care. The goal is to get the most efficient treatment possible, avoid out-of-network charges and receive more consistent advice.

“We encourage people to get annual physicals, regular health screenings, avoid hospital admissions and achieve good health,” Stelnik said.

Of the 1.5 million Arizonans covered by Blue Cross, roughly 73,000 are participating in the ACA marketplace, the company reported. Overall, ACA enrollment in Arizona has steadily increased to 203,000 in 2016, while the number of uninsured adults has decreased to an all-time low of 15 percent.

Lewis said he’s somewhat concerned that Blue Cross is the only carrier in 13 counties.

“What guarantee do you have they’ll be around? Past performance, I guess. They’re the last ones left standing,” he said.

Stelnik said Blue Cross has been serving Arizona for 75 years, including 50 years with individual plans, and will continue to offer coverage in 2017 so that all Arizonans have health care options.

REFORM OR REPEAL

Sen. John McCain, R-Ariz., said the expected rate hikes show that Obamacare is an “unsustainable system that places an unfair financial burden on families and small businesses.”

“While real families suffer the consequences of higher costs, less flexibility and less choice, Democrats continue to trumpet the successes of Obamacare and refuse to acknowledge the harm being caused by this fatally flawed health care law,” McCain said in a statement Monday.

But Rep. Ann Kirkpatrick, D-Flagstaff, said McCain isn’t being truthful in his criticism. Like many Democrats, she said ACA needs to be reformed, not repealed.

“In my mind, this isn’t a political issue,” Lewis said. “It’s been challenged in the U.S. Supreme Court and because it was upheld, that makes it the law of the land. At the end of the day, it’s in the best interest of people to know what’s in the law.”

Arizona once had the 10th-highest uninsured rate in the nation, more than 2½ times the unemployment rate, which placed a great burden on hospitals and emergency rooms treating the uninsured, Lewis said.

“I think there’s room for optimism. I think they’ll continue to figure this out,” he said. “They’ve got a vested interest of 20 million people, some of them with health insurance for the first time their life.”

Lewis covers four of the 11 largest counties in the United States – Coconino, Mohave, Apache and Navajo – and said he’s yet to meet one person who doesn’t want to be insured.

“They all have the same concerns,” he said. “How much will it cost? Am I going to be able to see my doctor? And what about my prescriptions? Another concern: What happens if something bad happens, an accident or cancer? Of Americans’ 100 greatest fears, No. 1 is health care.”

North Country HealthCare, located in 14 communities across Northern Arizona, has certified counselors on staff to help consumers understand their marketplace options and coverage for 2017. For more information, call (928) 522-9400 or go to www.northcountryhealthcare.org.