The open enrollment period for individual major medical insurance for 2018 is about to start Wednesday, and it's still not very clear how exactly the market for that product will work, or if it will really exist in much of the country.
It's not every clear whether the market will face cataclysmic change. Insurance markets have moved through tumultuous times before, inspired predictions of doom, and gone on to do just fine. The individual major medical market could still shock everyone by bobbling a bit and, in the end, doing just fine.
This will be the first full open enrollment period under the administration of President Donald Trump, and under his administrator for the Centers for Medicare and Medicaid Services, Seema Verma.
Trump has been trying to win major changes in the Affordable Care Act individual major medical product rules, and in the ACA public health insurance exchange system, by ACA programs that individual coverage issuers like.
But, aside from a little-discussed total ACA spending cut-off provision in an ill-fated House 2018 budget bill, no major Republican ACA change proposal that has come to the floor in the House or the Senate has sought to eliminate the ACA exchange system. Many have proposed replacements for the ACA advance premium tax credit and cost-sharing reduction subsidy programs, but none has actually eliminated the subsidies, and most would seem to keep subsidy spending roughly at 2017 levels for the next two years.
And CMS has been quietly trying to encourage agents and brokers to do business with HealthCare.gov, a federal system that provides ACA exchange account setup and administration services for coverage issuers and residents in 39 states.
It's not easy for a member of the public to know how many of the issuers still in the individual market will pay agents to send them business in 2018. It's possible, however, that some agents may continue to sell individual major medical coverage even if they do not earn commissions or enrollment fees, because they have figured out how to charge consumers user fees, or because they see helping consumers with major medical coverage applications as a way to generate leads for selling other, moneymaking products.
So, jeers from ACA haters and caterwauling from ACA lovers aside, what clues are there about how the individual market might actually work?
Here are a few new clues, gleaned from new documents and online data sources.
CMS Administrator Seema Verma (Photo: CMS)
1. The Centers for Medicare and Medicaid Services (CMS)
CMS Verma and another Trump administration official recently concluded that CMS lacks a valid congressional appropriation to make payments through the ACA cost-sharing reduction subsidy program, a program that helps low-income exchange plan users with their deductibles and coinsurance payments, and will stop making the payments.
CMS is reducing funding for exchange advertising and marketing support, and some exchange program supporters have accused the Trump administration of trying to sabotage the program.
CMS officials themselves say in a fact sheet emailed to reporters Wednesday that they are adjusting individual major medical marketing support to be more like Medicare program support, and focusing their resources on the marketing programs and strategies that have worked best in the past.
"This year's outreach and education campaign will target people who are uninsured as well as those planning to reenroll in health plans, with a special focus on young and healthy consumers," CMS officials say. "CMS committed resources to proven high impact, low cost digital outreach efforts including short YouTube videos, social media, and mobile and search advertising."
CMS will also continue to try to reach people using email, text messaging and autodial messages, officials say.
"Targeted email has proven to be the most cost efficient and effective way to reach consumers," officials say. "As part of this effort, CMS will send most consumers multiple emails per week, with increasing frequency as the deadline approaches."
Another clue to how well CMS might be supporting 2018 open enrollment efforts is the 2018 HealthCare.gov agent and broker registration count.
The registration numbers have been down about 30%, and only about 30%, from year-earlier figures since the start of the 2018 agent training period.
HealthCare.gov has also developed a new direct enrollment system that will make it easier for agents and brokers to sell exchange plans to people who qualify for ACA subsidies.
On Oct. 24, for example, about 38,000 agents and brokers had registered to sell HealthCare.gov coverage for 2018. That was down 30% from the 2017 HealthCare.gov producer count figure recorded Oct. 24, 2016.
It's possible that total HealthCare.gov sales could fall more than 30%, because the remaining agents are less interested in exchange plan sales, have less attractive products to offer, and have to cope with the fact that HealthCare.gov open enrollment is now set to end after just eight weeks, on Dec. 15, rather than extending to Jan. 31, as in the past few years.
But it's also possible that the remaining producers are the ones who have had the best results in the exchange plan market in the past, that the new direct enrollment system will increase their productivity, and that increased HealthCare.gov producer productivity will compensate for the fall in the number of products.
(Image: Thinkstock)
2. Bills
Avalere Health, a consulting firm that crunches health care systems numbers for insurers, drug makers and other organizations interested in health care, says it believes the full cost of mid-level, "silver" level exchange plans will increase 34%.
