RALEIGH (May 24, 2018) – North Carolina Marketplace enrollees have benefited from efforts to mitigate harm to customers in aftermath of the Trump administration’s decision on cost-sharing reductions, according to new analysis from the NC Justice Center.
Late last year, President Trump cut off reimbursements for cost-sharing reductions, which are legally required discounts on deductibles and other out-of-pocket costs on Health Insurance Marketplace plans to eligible enrollees. However, insurers, state regulators, and advocates had prepared for the scenario, devising a strategy known as “silver loading” to alleviate market instability and additional hardship for customers.
North Carolina Marketplace enrollees on the whole have benefited from silver loading, the new report shows. Thanks in part to silver loading, take-up of cost-sharing reduction plans with the greatest consumer protections remained strong among eligible North Carolinians—those with incomes up to 200 percent of the federal poverty level. In addition, enrollment by North Carolinians who do not qualify for subsidies—mostly middle-income folks—remained steady from 2017 to 2018.
“Silver loading not only prevented North Carolinians from being harmed by President Trump’s last-minute decision to cut off cost-sharing reduction payments, but it actually made better coverage more affordable to many North Carolinians,” said Brendan Riley, Policy Analyst for the NC Justice Center’s Health Advocacy Project. “However, due to a determined effort to sabotage the Affordable Care Act, premiums are likely to increase in 2019.”
Last month, Seema Verma, administrator for the Centers for Medicare & Medicaid Services, suggested that the Trump administration is considering barring the practice of silver loading. Even if it does not follow through, other federal policy changes—including opening the floodgates for short-term health insurance products and association health plans, as well as zeroing out the individual mandate penalty—will cause premiums to rise for North Carolinians in 2019.
“Even after generating record profits on its ACA business in 2017 and being handed windfall corporate tax breaks from Congress, Blue Cross Blue Shield of North Carolina and other insurers may still seek premium increases due to new policies that undermine the individual insurance market,” Riley said.
In the coming days and months, North Carolina insurers’ proposed rate increases should become public, revealing what the landscape may look like in 2019. This past year, Blue Cross raised rates by 14.1 percent—all of which was attributable to the cost of foregone CSR payments.
“Time will tell whether North Carolinians—like our neighbors in Virginia—may pay a higher premium due to conservative health care policies,” Riley said.