Donald Trump’s full impact on the U.S. health care system has yet to be felt. However, the day is coming soon for millions of Americans — right at the start of 2019. That’s when several efforts, including the GOP tax plan, kick into gear and start having an impact on the marketplace.
A February 2018 report by the Urban Institute broke down some of the elements of Trump policy that will affect health care premiums. All of the following will contribute to rising costs:
- Repeal of the Obamacare individual mandate
- The introduction of short-term, low-coverage plans
- Ending cost-sharing subsidies for the poorest Americans
While some states (including Massachusetts and New York) do not allow bare-bones plans on their marketplace, many others plan to do so. That will lead to an 18% increase, on average, in Affordable Care Act premiums for residents of 43 states. If you live in one of these places, get ready to pay up to 22% more for coverage.
Here are the 15 states where health care costs will go up the most in 2019.
If Trump’s proposal for short-term, cheap coverage goes into effect, ACA individual plans in Illinois will quickly rise. According to the Urban Institute, the average plan would go up 19.4%.
The analysis showed 94,000 Illinois residents would be affected. Overall, some 324,000 people in the state could end up without the minimum essential coverage.
Next: This southern state will get hit even harder.
The loss of the individual mandate, combined with competition from subpar health insurance plans, would shake the Georgia market even harder. On average, residents will premiums rise 19.5%.
Considering Georgia BlueCross BlueShield proposed rate hikes of 57% in October 2017, we’re not sure how much higher costs can go in this state.
Next: In New England, the story is the same, and it gets worse for older Americans.
13. New Hampshire
Up in New Hampshire, insurance markets will respond much like they will in the South and Midwest. On average, premiums would rise 19.6% if Trump’s short-term, limited plans reach the marketplace.
Of course, on the ACA exchanges, older Americans get hit the hardest. Anyone who does not yet qualify for Medicare yet must have coverage — mainly, those aged 50-64 — will feel the most burn.
Next: Residents of Mike Pence’s home state will have the “freedom” to pay about 20% more in health care premiums in 2019.
When describing the GOP’s plan to repeal the ACA, Vice President Mike Pence spoke of a glorious time ahead for the country. “ObamaCare will be replaced with something that actually works—bringing freedom and individual responsibility back to American health care,” Pence tweeted in February 2017.
That repeal never happened, and since then Pence and the Trump administration have had to settle for piecemeal efforts to undermine the health care law. Those efforts will give Indiana residents with ACA plans the freedom to pay 19.6% more for coverage in 2019.
Next: Rural health care coverage is about to get a lot more expensive.
When the Trump administration moved to end subsidies for the poorest Americans in June 2017, the two major insurers in Montana raised rates 12% (Pacific Source) and 22% (Montana Health) for ACA Silver plans. It’s another example of how seemingly unrelated moves on the market impact everyone.
Introducing bare-bones plans that compete with Obamacare will raise premiums yet again in 2019. On average, Montana residents will see costs jump 19.8%, with the highest increases for people over 50.
Next: This tiny East Coast state will feel the burn, too.
Mid-Atlantic states will feel the bite of the Obamacare sabotage as well. In Delaware’s case, Urban Institute sees ACA premiums rising 19.9% in 2019.
All told, some 76,000 Delaware residents would end up without minimum essential care.
Next: West Virginia is one of nine states that will see premiums rise 20% on average.
9. West Virginia
Urban Institute expects 112,000 West Virginia residents will end up without minimum essential health care in 2019 if Trump’s plans take shape. As for those who pay for ACA plans, premiums will rise 20% on average due to the shifts in the marketplace.
As the February 2018 teacher strike proved, employee-sponsored health care in West Virginia does not offer a much better alternative.
Next: Trump’s health care tinkering will have a huge effect on Wisconsin.
The combination of eliminating individual mandate penalty and introducing cheap, low-coverage insurance will hit Wisconsin hard. Those struggling to cover premiums at the current rate will see another 20% increase in 2019.
Altogether, Trump’s initiatives will leave 478,000 people in Wisconsin without minimum essential health care.
Next: Texas’s health care troubles will get worse in 2019.
The Lone Star State really felt the pinch when Trump ended cost-sharing subsidies for poor residents. Approximately 600,000 were affected by that move.
Texans who paid full price for their health care through the exchanges felt the biggest burn. In 2019, another round of increases will come. On average, ACA plans will see 20.2% increases.
Next: Short-term, low-cost health care will spell more bad news for Nebraskans.
Urban Institute’s analysis has Nebraskans about to see ACA premiums jump 20.4% on average. Between the surge in uninsured residents and the impact of withdrawn subsidies, the marketplace can’t bear the Trump administration moves.
By mid-2019, health policy experts estimate 219,000 people in Nebraska won’t have minimum essential care. In a state of 1.9 million, that’s 11.3% of the population.
Next: This state is suing for Obamacare repeal following the GOP’s removal of the individual mandate fine.
If you thought talk of Obamacare repeal was done in 2018, think again. In the final week of February, Arizona joined 20 states (mostly in the South and Midwest) in a federal lawsuit calling for a full death for the ACA.
While state lawyers wage that war, residents will prepare to see health care premiums skyrocket in 2019. On average, ACA plan holders will pay 20.6% more for coverage.
Next: In 2019, a second New England state will feel the brunt of rising health care costs.
4. Rhode Island
Among the states hit hardest by Trump’s health care policy, Rhode Island stands out from a pack of mostly red states. Residents paying for Obamacare plans will see 20.7% increases in their coverage.
Once again, older Rhode Islanders will see the biggest increases in the coming year. As for 2020, no one can predict how expensive the situation will get by then, but plan on another double-digit increase.
Next: This sparsely populated state is set to end up with 57,000 lacking decent coverage.
3. North Dakota
Out in the Dakotas, the rural health care market won’t improve under Trump. Urban Institute expected 23.4% to end up without minimum essential coverage by next year.
With the administration’s new plans ready to hit the market, the rest of the population will pay dearly for any medical services. All told, it will run the typical North Dakota resident with an ACA plan 20.8% more in 2019.
Next: In one of America’s poorest states, health care will get even more expensive.
Among those covered by the ACA in Alabama, 94% received either tax credits or cost-sharing subsidies from the federal government in 2017. Now that changes are in the works for those policies, everyone will pay more in 2019.
The average plan will see premiums jump 21.6%. Meanwhile, 767,000 Alabama residents will find themselves either uninsured or without minimum essential coverage.
Next: No one will feel the pain like South Dakota residents.
1. South Dakota
While everyone will see higher health care premiums under Trump, no one will shoulder the burden like South Dakota residents. On average, folks with an ACA plan will see 21.7% higher premiums in 2019.
When the Trump administration realized repealing Obamacare would be impossible, it decided to attack the ACA from a number of alternate ways. As a result, every American who wants health insurance will end up paying more. It’s just a matter of “how much” at this point.
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