Are we still talking about Obamacare?
Somehow, over seven years since the Affordable Care Act became law, Americans still have to worry about it, discuss it, and scream at members of Congress about it. No matter how popular it has become, hardly a week goes by without lawmakers trying to repeal it.
After another repeal effort failed in September 2017, President Donald Trump took matters into his own hands. In the second week of October, Trump signed an executive order to end subsidies to people with the Affordable Care Act who have the hardest time affording deductibles and copays.
According to figures from the Centers for Medicare and Medicaid Services, nearly 6 million low-income Americans depend on these subsidies. Once the government stops making payments, insurance companies either will have to raise premiums by huge amounts or abandon the market. Already regulators approved rate increases of over 40% in some states. If insurance companies decide to leave, hundreds of thousands will lose coverage.
So welcome to Trumpcare. If you live in a state with a high number of people benefiting from subsidies, health care costs will soar, pushing prices beyond reach. Here are the 15 states that will be hit hardest by Trump’s executive order on health care.
On the Hawaiian islands, the number of Affordable Care Act enrollees receiving subsidies (9,859) might not be high, but the percentage is quite significant. Centers for Medicare and Medicaid Services statistics show 59% of those with the Affordable Care Act benefit from the cost-sharing reductions. Hawaii is one of the few states on this list that did not vote for Trump in the 2016 election.
Next: This state’s lone House representative stands with Trump in ending subsidies.
14. South Dakota
In South Dakota, where Trump received over 60% of the vote in the 2016 election, about 6 in 10 Affordable Care Act enrollees will see subsidy payments end. Stats from the Centers for Medicare and Medicaid Services show 16,144 people receiving these subsidies in 2017. As a percentage of those on Affordable Care Act plans, 59% will be affected. But Kristi Noem, the state’s lone House representative, said she supported Trump’s executive order.
What that will mean for the rest of South Dakota should worry anyone with private insurance. While Sanford Health will remain in the state for the time being, a Sanford spokeswoman told the Associated Press rates would rise more than the company expected a few weeks ago.
Next: More than 100,000 people in this Southern state will see subsidies end.
The percentage of Tennessee residents who voted for Trump (61%) is quite close to the number of Affordable Care Act enrollees who will see subsidy payments end (59%) as a result of the executive order. All told, some 118,901 people in the Volunteer State will be affected. Prior to the Trump order, Cigna had approval for 36% rate increases in Tennessee, while Blue Cross quoted 21% increases. Those numbers will rise again without a change in policy.
Next: Over 200,000 residents here will kiss subsidies goodbye.
If the number of Tennessee residents receiving cost-sharing subsidies sounds high, Virginia’s statistics will give even more people pause. The Centers for Medicare and Medicare reported 218,241 Old Dominion residents were set to receive subsidies. However, the state government had already planned for the Affordable Care Act sabotage. This move might keep prices stable for 2018, but Virginia officials expect more rate hikes and possible insurer exits.
Next: After a 75% increase in rates, this state will once again see higher prices.
Most Oklahoma residents thought health care could not be more expensive. Following a 75% rate increase in 2016, the lone insurance company left on the state’s exchange (Blue Cross) said prices will go up again after Trump’s action. Currently, 80,548 residents (62%) of the Sooner State receive subsidies for their Affordable Care Act plans. Blue Cross announced rate hike before Trump’s executive order, citing potential instability in the marketplace. That’s all it takes for people to pay more for health care.
Next: Out west, this state raised rates 39% in anticipation of Trump’s executive order.
In late September, Utah officials were bracing for something like the Trump order that came weeks later. Tanji Northrup, the state’s assistant health insurance commissioner, described it as “the million-dollar question” in comments to the Salt-Lake Tribune. Anticipating that 109,204 Utah residents (62%) will lose federal subsidies, insurance companies got approval for 39% rate hikes for 2018. That will price out many people who pay for their own plans.
Next: More than 150,000 in this New England state will see subsidies disappear.
Only one blue state made the top 10 among those that will feel the sting most from Trump’s executive order. Some 62% of those on the Affordable Care Act (150,682) in the Bay State will no longer have subsidies go to insurers on their behalf. As a result, others without employee-sponsored plans will see rates go up as much as 29%, according to CommonHealth. Maura Healey, attorney general of Massachusetts, joined 18 other states in a lawsuit aimed to block the executive action.
Next: Over 600,000 people in this populous state will watch subsidy funding end.
The bigger the state, the more people who will lose federal subsidy funding. Texas, where some 605,000 people (63% of enrollees) qualified for subsidies, will be a major test case for Trump’s executive order. According to one Dallas-based health care startup, Texans who pay for the full cost of their insurance will “crushed” by the move. The 20% increases baked into next year’s rates will likely take another jump when insurers crunch the numbers in 2018.
Next: More than two-thirds of this red state receive subsidies for Affordable Care Act coverage.
Trump won Idaho in a landslide, but he didn’t do the state’s middle class any favors with his executive order. According to the Statesman, the cost of silver plans on the exchanges soared 40% in expectation of Trump’s move. Someone will have to pay for the lost subsidies of 56,000 people (66% of enrollees). As in every other state, insurers respond first by passing along the cost to consumers. In 2018, they might exit the market if the math gets worse.
Next: More than 300,000 people will have subsidy payments cut in this Atlantic state.
6. North Carolina
As in 2012, North Carolina voted for the GOP nominee, and this Trump state will see 300,255 residents (67%) on the Affordable Care Act lose subsidy payments. In mid-October, Blue Cross announced a modest (14%) rate hike in response. However, any North Carolina residents with cheaper plans grandfathered in prior to 2010 will see costs double or triple, News & Observer reported. One Outer Banks couple saw monthly premiums jump from $1,241 per month to $2,919.
Next: More than 7 in 10 residents of this Southern state depended on subsidies.
In the five states with the highest number of residents receiving subsidies under the Affordable Care Act, more than 7 in 10 depend on the funding. Insurance companies in Georgia, which has 286,076 people (71%) fall under this category, prepared for the worst by raising premiums 50% in September. Tens of thousands of people with insurance will feel the effects until the terms get evaluated again in 2018.
Next: Responding to threats and verbal warnings, this state got out in front with a 31% rate hike.
4. South Carolina
Blue Cross, the only Affordable Care Act insurer left in South Carolina, said it prepared for instability like many other companies: by baking big premium increases into the cake. Before setting rates for 2018, Blue Cross decided on a 31% hike over the previous year. That’s the only way it could manage the change to plans for 72% of Affordable Care Act enrollees (132,649 residents) receiving subsidies. If that doesn’t work, Blue Cross might have to leave South Carolina.
Next: More than 1 million people in this state depend on subsidies.
Though Florida is nowhere near the most populous state in the union, the Sunshine State has the most residents (1.07 million) receiving subsidies on Affordable Care Act coverage. In fact, 3 in 4 low-income Floridians (75%) qualified in 2017. These massive figures would explain why insurance companies raised premiums 45% ahead of the new coverage year. Any Florida resident without employer-sponsored coverage will pay dearly.
Next: In this state down south, 94% of those insured under the Affordable Care Act receive assistance.
The Affordable Care Act stats in Alabama, where voters went for Trump at a 2-to-1 margin, are staggering. Between the 77% (116,722) receiving subsidies and others receiving tax credits for health care, some 94% receive assistance for their health care coverage. Their fate will remain uncertain in the coming months as Trump’s order starts to play out, but one state expert predicts steep rate hikes for anyone with a pre-existing condition in the near future.
Next: The red state where 4 in 5 depend on subsidies
Whether you look at the numbers insured under the Affordable Care Act or the percentage of those benefiting from subsidies, Trump states have the most to lose. In Mississippi, where 80% low-income residents (53,632 enrollees) receive this type of help, no other state can match the percentage at risk. We imagine that’s why state officials approved a whopping 47% rate hike for 2018, the Clarion-Ledger reported.
As a result, Mississippi Insurance Commissioner Mike Chaney told the newspaper as many as 10,000 people could lose their insurance. They simply wouldn’t be able to afford coverage anymore. When the Clarion-Ledger asked how they would regain insurance, Chaney was at a loss. “I have no answer for that,” he said.
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