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Appalachia Health News tells the story of our health challenges and how we overcome them throughout the region. 

Premiums are Going Up in 2017. The Good News? Most Won't Be Impacted.

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The fourth annual open enrollment for health coverage through the Affordable Care Act begins today. Over the past year, more West Virginians than ever before have become ensured, including thousands with preexisting health conditions. But the first three years of the ACA have been far from smooth. Premiums and deductibles continue to rise, and more and more insurers are leaving the marketplace. Kara Lofton talked with Timothy Jost, an emeritus professor of law at Washington and Lee University and ACA expert about what consumers can expect for 2017.

On what impact the elections will have on the Affordable Care Act

Depending on who wins it could have a very great impact. Donald Trump has said that he will repeal the Affordable Care Act. He can't do that unilaterally, but important provisions of the Affordable Care Act like the Medicaid Expansion and Marketplaces could be repealed. If Hilary Clinton is elected I think she is going to try and work with some of the problems the Marketplaces are currently struggling with. If she can get Congress to work with her I think those problems are solvable. 

If things continue as is, what can West Virginians expect to change for health coverage in 2017?

West Virginian has a very interesting situation in terms of health care coverage. It has the highest rate of Medicaid coverage and highest rate of Medicare coverage in the country. It also has one of the lowest rates of uninsured, which has come down significantly since the ACA. So if things continue as they are, most West Virginians will keep their coverage. However, for the people insured in the individual market premiums are going up pretty precipitously by about 32 percent, which is in the upper quarter of states in the United States.

The Department of Health and Human Services recently released a report analyzing the premiums consumers will have to pay for 2017 marketplace coverage. In it they project that after two years of moderate premium increases, premiums are going to go up sharply for 2017. Is West Virginia impacted by this trend?

Yes it is. Premiums are going up in West Virginia more than they are in many other states. They are projected to go up about 32 percent next year. Now it's important to realize that this is only for people in the individual market who don't have premium tax credits, which is a quite small percentage of the total population. For people with premium tax credits their premiums will likely be almost exactly the same as they were last year.

What are tax credits exactly and who is impacted by them?

Premium tax credits are basically assistance from the federal government that's made available to people who have incomes of 400 percent or less of the federal poverty level who aren't eligible for other forms of coverage like affordable employer coverage. They help pay for health coverage when it's purchased through the marketplaces.

Will tax credits offset premium increases for a majority of the population?

Tax credits will offset premiums for 85 percent of people who enroll through the marketplaces. And in fact because the premiums are going up, the tax credits are going to available this year to people with higher incomes than last year.

One concern is that insurers are leaving the marketplace. Has this happened in West Virginia?

West Virginia has the same number of insurers in the Marketplace that it has always had - two. The good news is insurers aren't leaving West Virginia, the bad new is there weren't that many to begin with. It's important to note, though, that just because you only have two insurers doesn't mean you only have two plans available. The average person in West Virginia has 13 plans available.

How are health care coverage trends different or the same than what is being seen in the rest of the country?

In many respects they are similar. Costs are going up everywhere. It's not just the cost of insurance, its the cost of pharmaceuticals and the cost of care. But West Virginia is unusual in that it is a lower income and older population than many other states. It also has the highest percentage of the population on Medicaid and Medicare. So I think that West Virginia just has a population that is going to use more health care than many other states and that just leads directly to higher costs.

Appalachia Helth News

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.


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