Health Care ACA Troubles

In this Nov. 1, 2018, file photo, the federal website where consumers can sign up for health insurance under the Affordable Care Act is shown on a computer screen in Washington. The health care sector is getting punished before the opening bell Monday, Dec. 17, after a federal judge in Texas ruled Friday that the Affordable Care Act is unconstitutional. (HealthCare.gov via AP, File)

Utahns signed up for 2019 health insurance in droves during the final week of open enrollment ending Dec. 15, and that late rush brought the state’s totals on par with last year, despite Republican-led efforts to dismantle the Affordable Care Act known as Obamacare.

The Centers for Medicare and Medicaid Services released week seven and cumulative totals on Dec. 19, indicating that 194,813 Utah residents selected Marketplace insurance coverage on healthcare.gov between Nov. 1 and Dec. 15 — an astonishing surge over 97,931 at the end of week six. In 2017, Utah enrollees totaled 195,121.

Nationwide, almost 8.5 million people enrolled in ACA-approved health care plans this year, roughly a 4 percent dip from about 8.7 million in 2017. Of that 2018 total, about 24 percent were new customers, and the rest were renewing coverage.

RELATED: Utah open enrollment providers say more choices available for health insurance sign-up

Randal Serr, director of Take Care Utah — a network of nonprofit organizations that connects people to health insurance — was thrilled to see Utah’s tally.

“It’s gratifying because we spend most of our time figuring out how to get more people access to health care,” Serr said. “So when we see numbers like that, it shows there is a need out there, and there are 194,000 people getting access to the care they need. It’s a good reward toward the end of the year.”

According to Utah public health data, an estimated 264,900 Utahns — about 8.7 percent — lacked health insurance in 2016, the lowest rate in over a decade. But a nationwide 2018 Gallup poll showed Utah with a 2.1 percent increase in its uninsured population in 2017, due in large part to declining ACA enrollment.

After President Donald Trump took office in January 2017, the GOP push to gut the ACA intensified. The enrollment period was cut in half, public marketing fell considerably and funding for trained navigators to assist in enrollment got slashed. Federal CMS data showed ACA enrollment peaking at 12.7 million in 2016, then declining roughly 3.9 percent in 2017 and dropping another 3.7 percent last year.

The Henry J. Kaiser Foundation tracked this decrease in navigator funding, showing Utah’s 2016 award of $902,681 shrinking to $394,862 in 2017 and $113,814 by 2018.

Former President Barack Obama signed the Affordable Care Act into law in March 2010, but much of it did not take effect until 2014. Medicaid expansion, funded mostly by federal dollars except for a maximum 10 percent state match, was a key component of the ACA to provide individuals with incomes up to 138 percent of the Federal Poverty Level ($34,638 for a family of four) access to affordable health care.

But a 2012 U.S. Supreme Court ruling, while upholding the law’s constitutionality, gave states the prerogative to choose whether to fully expand Medicaid. For years, a majority of Utah lawmakers balked at full Medicaid expansion due to sustainability concerns. However, this November, 54 percent of Utah voters approved Proposition 3 to fully expand Medicaid and fund the state’s match with a .15 percent tax increase on non-grocery purchases.

Proposition 3 is scheduled to take effect April 1, 2019. Kolbi Young, Medicaid spokeswoman for the Utah Department of Health, said work is under way to be fully prepared by that date.

“There are a lot of moving pieces and a lot of coordination with the federal government to get approvals and to be able to make the program operational for Utah,” Young said. “We are doing the heavy lifting now to meet that deadline.”

In terms of how Proposition 3 will affect recent Marketplace enrollees, Young said that people who earn up to 138 percent of the Federal Poverty Level will get the opportunity to switch to Medicaid in April. And they could fare better on Medicaid due to lower co-pays and lack of premiums.

“Medicaid is a comprehensive program,” Young said, “and depending on income and what category of assistance people are eligible for, their investment is usually less on Medicaid.”

On Dec. 14, a federal judge in Texas — U.S. District Judge Reed O’Connor —ruled that the entire Affordable Care Act is unconstitutional. While seen as a significant blow that could wreak havoc on U.S. health care systems, the law remains in place pending potentially lengthy appeals to O’Connor’s ruling.

Cathy McKitrick is a freelance journalist. You can follow her on Facebook or Twitter (@catmck). She can also be reached at catmckit@gmail.com.

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