July 28, 2017 – updates regarding individual insurance

I promised you that as updates happened to the Affordable Care Act that I would give you a clear concise analysis of what the updates are and how they apply to you. Last night’s vote in the Senate did nothing to the current law of the land. The law does however have some issues that are coming up. One of the issues is the expiration of funding for the subsidies19508354_s used to assist people with the high deductibles and coinsurance when they have a lower income, defined as at or below 250% of the federal poverty level. These payments to the insurers are scheduled to stop this year. Insurers are obligated by the Affordable Care Act to grant the subsidies, known as cost-sharing reductions, to eligible customers. At this point, failure to address this issue is expected to increase premiums for individual coverage 15 – 30% for 20181. Currently companies offering individual plans have filed rates with the commissioner with the prediction that these payments will stop and have a chance to change the rate before the plans are actually set to release. I, like you, will be waiting for the November 1st release date to actually see the rates.

The state of Wisconsin could do something to help reduce the price hikes for premiums for Wisconsinites. The state could apply for at 13:32 waiver and set up a program to help with the very ill. This waiver is what the state did to keep the BadgerCare plus program for children under 193.

Currently approximately 20% of the population creates 80% of the health care costs in this county 4. If the state were to create this waiver they could in act an underlying program that helped the insurance carriers mitigate the costs to consumers while working with providers to manage this specific populations cost in a more cost effective and innovative manner much like the HIRSP of old 5.

The time is now for them to act but I have heard nothing. I also have heard no mention of cost control or requiring providers of healthcare to disclose prices so consumers are aware and can shop if they want to. I have seen more and more difficulty trying to determining pricing before procedures and no transparency. Please be aware many hospitals will not send out detailed billing unless you specifically request it.

To date companies that offer individual insurance in Wisconsin have reported large losses. If there are any winners with the ACA it is not the insurance companies. The only ones seeing record profits are the hospital systems 6. Anthem Blue Cross has decided to stop offering individual coverage in Wisconsin except for in one smaller County. Wisconsin now only has 13 companies statewide that will be selling individual plans 2. Remember plans are regional and in most counties you may have 2 or 3 carrier options. In some counties like Kewaunee you will only have one company in others it is rumored that there might be no options. People often come to me and say, “Well I will just go off the marketplace and buy a plan.” What people fail to grasp is that if they are not selling… they are not selling…. There is no magic plan that I can find for you.

The options today are:

  • ACA Compliant coverage (true health insurance regulated by the Commissioner of Insurance with no cap on coverage and no underwriting)
  • Short term (underwritten, 91 days at a time.) Changes to this option have made it difficult to use and not appropriate for most consumers.
  • Alternative plans (They are out there and they are underwritten. They are often called Christian plans but buyers beware as they are not regulated by the Commissioner of insurance – much like banking without FDIC protections.)
  • Indemnity plans ( This is often toted as an option but read the fine print as they really just pay you directly a small portion of what the bill actually is. You may still have huge medical bills)


  1. http://www.cnbc.com/2017/05/19/trump-reportedly-wants-to-kill-critical-obamacare-subsidies-despite-warnings-health-insurance-premiums-would-spike.html
  2. http://www.kff.org/health-reform/issue-brief/insurer-participation-on-aca-marketplaces-2014-2017/
  3. https://www.dhs.wisconsin.gov/dhcaa/memos/13-32.pdf
  4. http://www.politifact.com/oregon/statements/2012/feb/23/alan-bates/does-20-percent-population-really-use-80-health-ca/
  5. http://echealthinsurance.com/wisconsin-health-insurance/public-assistance/health-insurance-risk-sharing-plan/
  6. https://www.forbes.com/sites/brucejapsen/2015/03/01/hospital-profits-soar-as-obamacare-prescribes-more-paying-patients/#68a07da74da9