Several states will see major changes to the non-group market under ACA repeal, UMass Medical School expert says

June 05, 2017

Roughly one-sixth of the country lives in states that are likely to seek waivers under the American Health Care Act (AHCA), which could dramatically revamp the individual, or non-group, health insurance market, said UMass Medical School expert Terry Dougherty, MPH.

The AHCA, recently passed by House Republicans, would give states the ability to waive core parts of the Affordable Care Act (ACA) and dramatically restructure their insurance markets. The Congressional Budget Office (CBO) in its AHCA cost estimate released May 24 said the waivers could lead to market instability.

Texas, Tennessee, Florida, Georgia, Wisconsin and Kentucky are seen as most likely to apply for these waivers, Politico reports.

The House repeal bill would give states the green light to move sicker individuals into separate insurance pools with the aim of reducing premiums in the overall market for healthier individuals.

However, premiums for people put into these “high-risk” insurance pools are likely to soar, pricing many people out of the market altogether, Dougherty contends.

“There is a fairly strong prediction that for those folks coverage will be completely unaffordable for them and you still have a turbulent, non-group market for folks not in that group,” Dougherty said.

Particularly vulnerable to these potential changes are states that never expanded their Medicaid programs in the years after the ACA was passed in 2010, he says.

States that accepted federal subsidies under the health reform law and expanded their Medicaid programs enrolled millions of lower-income and other individuals who previously did not qualify.

But in states that opted not to expand Medicaid, many poor people were forced to buy insurance on the individual market through the health care exchanges created by the ACA.

And it is this market segment that could particularly see the most changes amid efforts by Republicans in Washington, D.C., to repeal and replace Obamacare.

“States who have not expanded Medicaid will obviously be impacted immediately,” Dougherty says.

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