Shortened Open Enrollment Might Mean an Unhealthier Risk Pool


Open enrollment for insurance through the Affordable Care Act marketplaces started last week. Things are a little bit different this year and recent announcements from the Trump administration have resulted in a fair bit of consumer confusion. So there are a few major changes to be aware of. First, this is a very shortened enrollment period.


“A 45 day period,” specifically, explained Michael Ross, manager of CareSource West Virginia. “And if people aren’t paying attention and you’re right there hasn’t been as much press about it, there hasn’t been a lot of pressing people to pay attention — I would really look at look, at your timeframes look at your dates and make informed decisions.”

Another change is that the federal government is paying for very little advertising this year, which in addition to the shortened enrollment period, could have a big impact on how many people enroll. Especially young people.


“We know that nationally it will result in about a million less people enrolling,” said Kelly Allen, lead navigator with the WV Healthy Start Navigator Project – a program that helps people figure out which health plans are best for them.

“And we think that those will be younger, healthier people because they are typically the people who waited until last minute and they are typically swayed by the advertising that the federal government isn’t paying for this year,” Allen said.

She said there also seems to be a lot of confusion about whether the Affordable Care Act is still the law — it is — and whether the penalties for not signing up for health insurance will actually be enforced.


“It seems like healthier people are kind of saying that they’ll take the risk and maybe go without coverage whereas people really have the need for health insurance are going to pay even as it gets more expensive,” Allen said.

Highmark Blue Cross Blue Shield West Virginia also provides insurance through the ACA marketplace. President Jim Fawcett said potentially fewer young people signing up is a big concern.

“Decisions being made at the federal level will impact who decides to purchase insurance,” Fawcett said. “And my guess is that the five percent that account for 50 percent of the expenses will stay in the pool. It’s keeping the other 95 percent of the people in there so we can share in the premiums.”

Premiums Rising

Speaking of premiums, West Virginia is seeing a big rise this year — about 29 percent for Highmark plans and 19 percent for CareSource plans on average. The increase will affect about 15 percent of West Virginians in the marketplace.

The other 85 percent, who earn between 100-400 percent of the federal poverty line, are protected by premium subsidies that are designed to keep insurance costs about the same for those in that income bracket.

Fawcett said those rate increases are directly attributable to the Trump administration’s announcement to cease Cost Sharing Reduction payments and uncertainty about whether the individual mandate – the requirement all Americans have insurance – would be enforced.

“Our premium increase, which is high, 25.6 percent, absolutely accounted for the uncertainty around both the cost sharing reduction and the individual mandate,” he said.

People really need to shop around, though, because they may be surprised how affordable a plan can be, said marketplace navigator Kelly Allen.

“People should just take a look and see what their options are,” she said. “About seven in ten West Virginians could also get a plan that’s $75 or less a month so I think that would surprise people. But it’s just kind of cutting through the political rhetoric to get that message out that’s really hard right now.”  

CareSource said it’s are committed to staying in the market and growing its share for the indefinite future. Highmark isn’t so sure. In the first three years the company has been in West Virginia, it has lost a lot of money. Fawcett said he thought those losses were going to level off this year, and may even turn into profits, but with all the turmoil going on in Washington, that may not be the case.


Appalachia Helth News

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health, Charleston Area Medical Center and WVU Medicine.