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Pennsylvania's Individual Affordable Care Act rates set to creep up in 2019

Wes Venteicher
| Tuesday, June 5, 2018, 1:15 p.m.
Cindy Shegan Keeley | Trib Total Media

Individual insurance premiums for plans sold on the Affordable Care Act's marketplace are going up by an average of 4.9 percent in Pennsylvania next year, according to the state Insurance Department.

The relatively small increase comes even as the “individual and small group insurance markets have been subject to intense and deliberate sabotage by the federal government in the past year,” according to a Tuesday news release from the department.

The department cited federal government decisions to shorten the period of time in which people can sign up for the plans and to eliminate the requirement in 2019 that everyone have health insurance.

It also cited President Trump's decision last year to eliminate federal funding for added benefits that had been included in plans for the lowest-income policyholders. The department cited that change last year when it approved an average rate increase of 30 percent for the plans. Increases averaged about 33 percent the year before that.

About 389,000 Pennsylvanians had bought the individual ACA plans and were paying their monthly premiums as of April, according to Centers for Medicare and Medicaid Services data. Most people with the plans don't pay the full percentage increase each year, since federal subsidies adjust their premiums according to their income.

“The majority of consumers will be shielded from this increase and any increase,” state Insurance Commissioner Jessica Altman told reporters Tuesday.

The rate increases don't affect people who get their insurance through an employer.

The average monthly premium for a 27-year-old living in Pittsburgh in 2018 was $293 per month before any adjustments from subsidies, according to a federal Department of Health and Human Services report. Premiums are higher for older people and those who smoke, and prices vary by region.

About 80 percent of Pennsylvanians receive the subsidies, which are available to people who make up to 400 percent of the federal poverty level — about $48,000 for an individual or $98,000 for a family of four.

The statewide average increase of 4.9 percent could include big variations in rate changes by region and by plan around the state. Insurers filed proposed rates on May 21. The Insurance Department isn't going to release region- or plan-specific rates until July 21 since insurers can adjust the requests before then based on input from the federal government.

Under federal law, the department reviews rate increases and can approve or deny the requests.

Altman said no insurers are leaving the Pennsylvania market next year. She declined to say whether any new insurers will be selling plans around the state. Only Highmark and UPMC Health Plan sold plans on the market in Southwestern Pennsylvania last year. Both insurers declined to share their proposed rate changes Tuesday.

The Congressional Budget Office has estimated premiums will rise an average of 15 percent around the country in 2019, attributing 10 percent of the increase to the elimination of the requirement that everyone have insurance. Altman declined to estimate the impact of the change on Pennsylvania rates.

The GOP included language eliminating the requirement in the tax overhaul. Insurers have said the repeal will require price increases in the ACA's individual insurance marketplace because more young, healthy people will likely choose to go without insurance, leaving older, sicker people with higher medical bills in the “pool” of those paying for insurance.

Pennsylvania's uninsured rate of 5.6 percent is the lowest recorded in the state, according to the Insurance Department.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676, wventeicher@tribweb.com or via Twitter @wesventeicher.

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