By LYNNE TERRY/The Lund Report
Open enrollment under the Affordable Care Act opens Nov. 1, just 10 days before a case on the law will be heard before the U.S. Supreme Court.
In Oregon and in many other states, residents can sign up for health insurance plans through the federal marketplace. Enrollment runs through Dec. 15.
Insurance officials expect a surge of interest this year because many people have lost their employer-provided insurance.
“We are definitely ready for hopefully a larger enrollment than we’ve seen in recent years,” said Amy Coven, spokesperson for the Oregon Health Insurance Marketplace. “A lot of the reason is because there have been unfortunately layoffs and job losses due to the pandemic, and so a lot of people are looking to shop for coverage where they haven’t needed to do that in the past.”
Since the pandemic hit, Medicaid enrollment has increased from about 1 million in Oregon to 1.2 million now. Another 2 million people have health insurance through their employer, and about 887,000 Oregonians are on Medicare or Medicare Advantage plans.
Currently about 145,000 individuals in Oregon have health insurance through the marketplace, with another 171,000 covered through a small group plan.
About 70% of residents who signed up for coverage this year through the marketplace qualified for federal subsidies. Generally, that’s consumers who earn less than $51,000 a year qualify.
On average, the subsidies cut individual insurance premiums by nearly $140 a month. They’re offered as a tax credit, which consumers can take monthly, or yearly on their federal income tax returns.
To find a plan, consumers can visit healthcare.oregon.gov to see if they qualify for subsidies, get free help choosing a plan and explore the options. https://healthcare.oregon.gov/Pages/index.aspx
The exchange offers more choices for next year, with Regence BlueCross Blue Shield joining the marketplace and offering plans statewide. People who were insured by Regence through their employer and lost that coverage due to a layoff might be able to get the same plan through the marketplace, Coven said, and at a lower rate than through the federal COBRA Act,, if they qualify for a subsidy.
Besides Regence, BridgeSpan and Providence, the biggest insurer in the Oregon marketplace, offer plans statewide. Kaiser Permanente, Moda, PacificSource offer plans in certain counties. Everyone, though, has a choice of at least 15 plans and in some counties, 23 plans are available, Coven said.
All companies are required to offer three plans with varying costs and coverage, from bronze to gold, the most comprehensive and expensive.
The marketplace also sells dental plans from PacificSource, Oregon Dental Services, or ODS, Dentegra, Dominion, Dental Health Services and Kaiser Permanente, with at least 13 plans available in each county.
Overall the premium prices of medical plans will remain fairly flat next year, with the Department of Consumer and Business Services approving a weighted average premium increase of 1.8%.
The marketplaces created through the ACA do not allow insurance companies to reject people with pre-existing conditions, such as heart disease, diabetes or COVID-19.
The ACA also requires insurers to cover 10 “essential health benefits” including preventive care, mental health care, hospital visits, emergency care and coverage during pregnancy and birth. https://www.healthcare.gov/coverage/what-marketplace-plans-cover/
But those provisions could be struck down if the Affordable Care Act is deemed unconstitutional by the U.S. Supreme Court, which will hear oral arguments on Nov. 10 and will include newly appointed conservative justice Amy Coney Barrett.
The case before the court, Texas v. United States, dates to 2012 when the Supreme Court upheld the constitutionality of the so-called personal mandate in the law which required Americans to have health insurance or pay a fine. In 2017, the Republican-controlled Congress eliminated the penalty. That prompted several Republican state attorneys general to file the suit to try to overturn the ACA. Their argument is that the penalty was such a major part of the law that without it, the ACA is no longer valid.
It’s unclear what will happen. Elimination of the law could scrap all of the provisions of the ACA, including the subsidies and guarantees for people with pre-existing conditions.
While the litigation continues, the law will stand. The court is likely to decide the case by the end of its term in June next year.
Oregon state insurance officials are following it closely.
“That’s definitely something we’re keeping an eye on,” Coven said.
“We’re not anticipating any changes in the near future.”
- YachatsNews is a subscriber to The Lund Report, a Portland-based nonprofit that covers health and the medical industry in Oregon.