King v. Burwell
The Supreme Court will issue a ruling in King v. Burwell later this month, and a lot hinges on the outcome. Louisiana uses the federally facilitated marketplace (FFM), so if the court rules that subsidies are only legal in state-run exchanges, 143,000 people in Louisiana would lose their subsidies. And premiums in the entire individual market would climb substantially if that happened, because healthy people would be likely to drop out of the insurance pool, leaving sicker people with higher claims.
At ACAsignups, Charles Gaba estimates that striking down the subsidies would result in unsubsidized average premiums climbing from $416/month in 2015 to $624/month in 2016. Most current enrollees in the Louisiana exchange have subsidies however, so the result for them would be much more profound: Their rates would climb from an average current (after-subsidy) premium of $93/month to $624/month next year.
2016 rates have already been filed by carriers, but the Louisiana Department of Insurance confirmed that if the subsidies are stuck down by the Supreme Court, carriers will have two weeks to refile new (presumably much higher) rates for 2016.
More than 184,000 Louisiana residents selected qualified health plans (QHPs) through the marketplace during 2015 open enrollment.
2015 enrollment is about 83,000 higher than 2014 enrollment. However, Louisiana residents signed up at a slower rate than individuals across the nation. About 35 percent of eligible Louisiana residents signed up for coverage through the marketplace compared to about 41 percent nationally.
Special options for enrolling
While the 2015 open enrollment period is over, you may still be able to sign up if you meet one of the following conditions.
- You experience a qualifying event. You have 60 days from the date of the event to sign up for insurance.
- You are a Native American. You can sign up for health insurance at any time during the year.
- You qualify for Medicaid. Medicaid accepts applications throughout the year.
Rates and carriers for 2015
The number of insurance companies selling through the marketplace in Louisiana grew from five to six for 2015 coverage according to the U.S. Department of Health and Human Services. UnitedHealthcare, the nation’s largest health insurance company, joined the marketplace in Louisiana and about 20 other states. United took a very conservative approach in 2014, participating in just five states.
The Commonwealth Fund analyzed premiums and deductibles across all the metal tiers, differences in premiums between urban suburban and rural areas, and insurer participation in nearly all states. For Louisiana, the analysis showed premiums up 12 percent on average. In contrast, the analysis showed a 0 percent change in premiums nationally. According to another study by the Commonwealth Fund, premiums in state individual insurance markets rose an average 10 percent or more each year from 2008 to 2010.
Paying more for NOT being covered
Penalties, like premiums, are rising. If you don’t qualify for exemption and don’t get health insurance in 2015, you’ll owe a penalty when you pay your 2015 taxes. 2015 penalties are the greater of:
- 2% of annual household income
- $325 per adult or $162.50 per child under 18
There are caps that limit penalty amounts. See HealthCare.gov for a list of exemptions and penalty caps.
2014 enrollment recap
During 2014 open enrollment, 101,778 Louisiana residents signed up for a qualified health plan (QHP). Eighty-eight percent of QHP enrollees received financial assistance, and their average monthly premium after subsidies was $83 according to a federal report.
More than 17 percent of Louisiana residents were without health insurance in 2014.
The Urban Institute estimates Louisiana’s enrollment in the marketplace will reach 305,000 in 2016.
ACA and exchange implementation in Louisiana
Louisiana is among the 26 states that left all responsibility for its health insurance marketplace to the federal government. Gov. Bobby Jindal repeatedly rejected a state-run exchange and even returned a $1 million federal planning grant.
Jindal also rejected Medicaid expansion in the state, a decision that leaves 34 percent of uninsured Louisiana adults in the coverage gap, so they can’t get help through Medicaid nor do they qualify for subsidies to purchase insurance through marketplace. According to the Kaiser Family Foundation, almost 242,000 Louisiana residents are shut out of both Medicaid and subsidies to purchase insurance through the marketplace.
The decision against Medicaid expansion affects not only uninsured individuals, but also Louisiana healthcare providers and its overall economy. The state provided $18 million in stopgap funding in late August 2014 when Baton Rouge General Mid City Hospital announced it would close its emergency room due to the expense of providing uncompensated care for the uninsured. Despite the infusion, the emergency room will close by early April 2015. An Urban Institute study says Louisiana is losing out on $15.8 billion in funding between 2013 and 2022 by not expanding Medicaid, while contributing $5.7 billion in taxes over the same period that will be used states that have expanded.
Louisiana health insurance exchange links
State Exchange Profile: Louisiana
The Henry J. Kaiser Family Foundation overview of Louisiana’s progress toward creating a state health insurance exchange.
Louisiana Department of Insurance, Office of Health Insurance
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Louisiana.
(225) 219-4770 / Toll Free: (800) 259-5301