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Alabama health insurance

Two insurers offer 2019 coverage through exchange and both proposed rate decreases.

Health insurance in Alabama

Alabama’s health marketplace

Alabama uses the federally facilitated marketplace, so residents enroll in exchange plans through HealthCare.gov. For 2019 coverage, open enrollment will run from November 1 through December 15, 2018.

Two carriers – Blue Cross Blue Shield of Alabama and Bright Health – will continue to offer plans through the exchange. Both insurers filed 2019 rates that are lower than last year.

Read more about Alabama’s health marketplace.

Enrollment in qualified health plans

The Kaiser Family Foundation in 2013 estimated Alabama’s potential market size to be 464,000 people and that 270,000 of them would qualify for tax credits to help lower their premiums. As of April 2014, there were 97,870 people enrolled in qualified health plans (QHPs) through Alabama’s health insurance exchange.

Alabama’s 2016 exchange enrollment was up 14 percent over 2015, with 195,055 enrollees. Forty-three percent of those enrollees were new to the exchange for 2016.

For 2017, enrollment declined to 178,414. Enrollment declines were widespread for 2017 in states that use HealthCare.gov, due in part to the nascent Trump Administration’s decision to reduce marketing and outreach in the final days of open enrollment in January 2017.

For 2018 coverage, about 170,000 Alabamans enrolled through the Alabama exchange.

Medicaid coverage in Alabama

Alabama has not accepted federal funding to expand Medicaid under the ACA. An estimated 314,000 Alabamans would gain coverage if the state were to accept federal funding to expand the program. In 2018, the federal government pays 94 percent of the cost of Medicaid expansion, and that will drop to 90 percent by 2020, remaining at that level going forward.

Read more about Alabama’s and ACA’s Medicaid expansion.

Short-term health insurance in Alabama

Alabama doesn’t have state regulations for short-term health insurance plans, so the state defaults to new federal regulations. That means short-term plans are allowed to have initial terms up to 364 days, and total duration – including renewal – of up to 36 months.

Read more about short-term health insurance in Alabama.

How the ACA has helped Alabama

While it may not be seeing the nation’s largest improvements, Alabama is seeing improvements under the Affordable Care Act. According to US Census data, the uninsured rate in Alabama in 2013 was 13.6 percent, and that had fallen to 9.1 percent by 2016. The national uninsured rate was 8.6 percent by 2016, but Alabama has rejected federal funding to expand Medicaid, leaving an estimated 75,000 people in the coverage gap, with no realistic access to health insurance.

The vast majority (94 percent) of Alabama residents who enrolled in qualified health plans (QHPs) through Alabama’s health insurance exchange (i.e., Healthcare.gov) in 2017 received financial assistance to cover a significant portion of their premiums. Average premium subsidies in Alabama in 2017 amounted to more than $518 per month.

Alabama and Obamacare

In 2010, Alabama’s Congressional delegation opposed the health reform law. Sens. Jeff Sessions and Richard Shelby both voted no on the law while six Alabama representatives voted no in the House. Sessions has since been appointed Attorney General by President Trump, and a highly watched special election resulted in Doug Jones — a Democrat — winning Sessions’ former seat. Shelby remains in the Senate, so Alabama’s Senate delegation is split now, with one Democrat and one Republican. In the House of Representatives, Alabama has six Republicans and one Democrat. All of Alabama’s Republican Representatives voted yes on the American Health Care Act, which was the 2017 legislation that would have repealed major portions of the ACA. That bill ultimately died when it failed to pass in the Senate.

At the state level, then-Governor Robert Bentley indicated early on that he would support a state-run health insurance exchange, but ultimately sided with the state legislature, which decided to cede exchange control to federal government. Bentley was replaced in 2017 by Gov. Kay Ivey, who is strongly opposed to the ACA. The state has not accepted federal funding to expand Medicaid under the ACA.

Is there a high-risk pool in AL?

Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including Alabama.  Because pre-existing conditions were a factor in eligibility for coverage, some people were unable to purchase a private plan at all, or were only able to get one that excluded their pre-existing conditions.

The Alabama Health Insurance Plan (AHIP) was created in 1998 to give applicants an option for coverage if they were ineligible to purchase individual health insurance because of their medical history.  But unlike risk pools in many other states, AHIP was only available to applicants who were HIPAA eligible, coming off of a group plan with no more than a 63-day gap in coverage.

Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This change largely eliminated the need for high risk pools and MCHA stopped enrolling new members as of January 1, 2014.  In March 2014, the Alabama Senate passed SB 123, allowing AHIP to “cease operations upon allowing current participants enough time to transition out of the plan.” By 2017, the AHIP website was no longer operational.

Medicare enrollment in the state of Alabama

Alabama Medicare enrollment reached 968,010 in 2015, about 20 percent of the state’s population compared with 17 percent of the population enrolled in Medicare nationwide.

Historically, Alabama has had the second-highest percent of Medicare recipients listed as disabled, 24 percent, tied with Mississippi and just below Kentucky’s 25 percent. The other 76 percent of Alabama Medicare beneficiaries qualify based on age alone.

As of 2014, Medicare paid about $9,150 annually per Alabama enrollee each year. Based on data available for 2009, the state ranked 19th in overall spending with $8.04 billion annually.

Alabama Medicare recipients can opt to enroll in Medicare Advantage plans instead of original Medicare if they wish to gain additional benefits beyond what traditional Medicare coverage offers. 25 percent selected Medicare Advantage in 2015, compared with 31 percent nationwide.

Forty-seven percent of Alabama Medicare beneficiaries (455,086) are enrolled in Medicare Part D plans, which provide stand-alone prescription drug coverage.

Alabama health insurance resources

State-based health reform legislation

Recent Alabama legislation related to healthcare reform:

  • SB147 was signed into law and became Act Number 2015-227 in May 2015. This legislation ensures that insurance executive compensation in Alabama will be kept confidential. As such, it is not subject to open records requests, Freedom of Information Act (FOIA) requests, or subpoena.

Here’s a summary of other recent Alabama bills related to healthcare reform (the 2017 legislative session in Alabama ended on May 19):