For months health insurance providers on the New Mexico exchange have been struggling with uncertainty—over whether the Affordable Care Act would be repealed, and now over whether the White House will authorize subsidies to insurers after the month of August.
President Trump has threatened to stop cost sharing payments, which are meant to help insurers cover low- and middle-income customers.
KUNM spoke with Dr. Mark Epstein, Chief Medical Officer with New Mexico Health Connections, a nonprofit provider on the exchange.
Epstein: What’s happening is, not only New Mexico Health Connections but providers across the country are setting their rates for 2018. And part of figuring out your premium rates for 2018 is whether the cost share reduction—known as the CSR—will be there or not. And while the current administration in Washington has stated that they’ll be there through August, there’s no guarantee thereafter and into 2018. That degree of uncertainty is a challenge in terms of how rates are set, to make sure that the math works.
KUNM: So are we seeing insurers raise their premiums as a way to buffer against this uncertainty?
Epstein: What the Congressional Budget Office’s report has indicated was that on average maybe 20-25 percent increases are coming down the pike if the cost sharing reduction payments are not made.
KUNM: New Mexico hasn’t had the smoothest rollout of the Affordable Care Act—some insurers have even left the exchange. Could this uncertainty over the subsidies mean that we could be looking at more insurers leaving the state exchange?
Epstein: New Mexico Health Connections is fully committed to providing coverage through the individual market. In fact, as we were founded with funding through the Affordable Care Act, we are obligated to. And we embrace that as part of our mission and our vision. So we’ll be there without question in 2018.
This uncertainty however, coming out of D.C., makes it more challenging for carriers to stay in. So that is indeed a risk to the individual market.
KUNM: New Mexico Health Connections is the state’s low-cost option on the exchange. What about risks to your customers, or to people me or our listeners who rely on insurance for our health care?
Epstein: Well clearly if there are obstacles for affordability of health insurance premiums that make it a challenge for folks to purchase that coverage and get the care they need, that certainly is worrisome for all of us as a state. When driving improved health of our communities gets challenged, the more costly it is.
So what we’re looking for and what we’re focused on is how to keep premiums affordable and insure access to care. It doesn’t do anyone any good to reduce the amount of folks across the state who are covered, and end up in emergency rooms or otherwise foregoing care.
KUNM's Public Health New Mexico project is funded by the W.K. Kellogg Foundation and the McCune Charitable Foundation. Find this story and more at www.publichealthnm.org.