Health Care Act

Obamacare has been ‘very good’ for NC resident. But Trump action threatens health law.

Indian Trail resident Liz Auten said she pays nothing for the dozen prescriptions she takes everyday, including some to treat high blood pressure, diabetes and high cholesterol.

Auten is one of more than 300,000 N.C. residents who receive benefits from a federal subsidy that the Trump administration targeted Thursday to drop. That action could eventually drive away insurance companies from offering Affordable Care Act plans altogether.

The federal subsidy, called a cost sharing reduction, pays insurance companies to reduce the cost of out-of-pocket expenses, including copays and deductibles for Affordable Care Act plan participants.

“I’m on a fixed income,” said Auten, adding that her retirement income totals a little over $1,000 a month. By saving money on prescriptions, she can afford to eat one more meal in a week or pay for a tank of gas, she said.

The Trump administration announced Thursday it would stop paying insurers for the cost sharing reduction subsidy, which totals $7 billion per year nationally, according to national reports.

Health care experts said Friday that Auten and other residents in the Carolinas who receive the subsidy have nothing to fear about that action – yet. That’s because the tax credits that reduce the premium cost of ACA plans will not be affected.

In addition, the major ACA plan providers in the Carolinas anticipated those subsidies could get cut off and built that expense into the 2018 plans’ premium increases.

But the lack of funding could eventually cause ACA plan providers to pull out of the marketplace. The Trump administration said there is no budget appropriation for the payments so the government can’t pay them, according to the Wall Street Journal.

Critics say the Trump administration is sabotaging the federal health care law, also called Obamacare.

“I know there’s a lot of people that lambaste the Affordable Care Act and say it’s not worth anything ... but it’s been very, very good to me,” said Auten, 64, who will qualify for Medicare in March on her next birthday. “I’ve got absolutely no complaints.”

The Trump administration’s actions do not affect current ACA plan members or people who plan to enroll in 2018. Open enrollment begins Nov. 1.

“Although these announcements are alarming, nothing has changed for consumers,” said Madison Hardee, senior attorney for health care access with the Charlotte Center for Legal Advocacy.

That’s because insurance companies are legally obligated to provide the cost sharing reduction, she said. In addition, consumers who receive tax credits will see those tax credits cover premium increases.

“Consumers would be largely shielded from any increases in premiums that result from this announcement,” Hardee said.

In North Carolina, 356,560 residents who enrolled in a 2017 ACA insurance plan by the end of January received the subsidy. A total of 549,158 N.C. residents enrolled.

The uncertainty over the fate of the subsidies led to requests for double-digit premium increases proposed by Blue Cross and Blue Shield companies in both North Carolina and South Carolina.

Blue Cross is the only insurance company that offers individual ACA plans in all 100 counties in North Carolina and the only provider in South Carolina.

In North Carolina, Blue Cross has requested to increase premiums by a state average of 14.1 percent, a decrease from its initial request of 22.9 percent. That rate has not yet been approved by the N.C. Department of Insurance, which will announce the increase later this month.

“Ending (cost sharing reduction) payments will result in higher premiums for some of our customers next year, and the cost of coverage is already a burden for many,” the company said. “Additionally, stopping payments will make it harder for insurers to plan to participate in 2019.”

Meanwhile, South Carolina approved last month an average 31.3 percent increase for insurance premiums for about 200,000 residents insured through the Affordable Care Act’s individual marketplace. That will result in an average of a $10 or less increase in monthly payments for customers who qualify for a subsidy, according to Blue Cross.

“Our message to our existing customers and those who are exploring purchasing health insurance through the exchange is that, at this time, nothing has changed,” said Blue Cross South Carolina spokesperson Patti Embry-Tautenhan.

Cassie Cope: 704-358-5926, @cassielcope