Obamacare enrollment bustling in Nashville as Congress weighs ditching mandate

• To buy or not to buy: Congress proposes ditching the mandate.
• The costs are in the details, and people are paying more attention.
• Low premiums don't equal low cost. People gravitate toward middle-of-the-road plans.
• Need help navigating a plan? There are statewide resources.

Enrollment in health insurance on healthcare.gov is bustling around Middle Tennessee, even as Congress tries to repeal the individual mandate as part of its tax reform bill.

The number of people shopping for plans is keeping navigators — or those who help pick plans for free — as busy, if not more so, than the previous couple of years. 

It's been a year of near-constant political clamor to repeal and replace the Affordable Care Act as well as worries about whether the disappearance of an insurance subsidy would cause more insurers to exit. 

Even though the national advertising budget was cut for open enrollment by 90 percent by the U.S. Department of Health and Human Services, shoppers are finding their way to navigators. 

“It’s going at least as well as it has in any year, if not better. I think all the publicity about it has focused people on this is the time of year you do it and people want health insurance,” said Jackie Shrago, a volunteer navigator who helped set up Tennessee’s enrollment hotline when the exchange started.

Nationally, more than 1.47 million people signed up for health insurance Nov. 1-11, according to federal data.

In 2016, 1 million people signed up in the first two weeks. However, the enrollment period has been cut from 12 to six weeks. State-level data is not yet available. 

Sharon Barker, a navigator with Family & Children’s Service, said she’s getting more people by word-of-mouth referral than in previous years. In fact, at least four of the people who reached out to her on Thursday said a friend had sent them her way.

More:ACA open enrollment FAQ: What you need to know to get insured

To buy or not to buy: Congress proposes ditching the mandate

Mayra Torres wants to buy insurance for the first time this year so she doesn’t get hit with a penalty.

The Clarksville resident hasn’t had a tax penalty yet, but she doesn’t want 2018 to be the year she does.

In a twist to the tax reform debate, the U.S. Senate is proposing to repeal the individual mandate in its tax bill, a move that thrust health care reform back into the spotlight.

Repealing the individual mandate, and thus the tax penalty, would have some impact on how many people buy insurance but analyses vary widely.

The nonpartisan Congressional Budget Office projects that 13 million people would be uninsured over 10 years, saving the federal government $338 billion.

S&P Global Ratings projects, however, that 3 million to 5 million fewer would be insured with a $60 billion to $80 billion savings through 2027.

Fewer people buying into the insurance market would affect costs for those who do, said Larry Levitt, senior vice president of special initiatives at the Kaiser Family Foundation.

Health insurance, just as with car and home insurance, offers coverage from the pool of premiums paid by members.

People make monthly payments in exchange for coverage, and the aggregate pool of payments needs to cover the costs incurred by the members. The risk pool needs healthier people to counterbalance those who use more services.

Opponents of the mandate want buying insurance to be a choice. Tennessee requires drivers to have car insurance.

Shrago, who still sees first-time buyers motivated by a prior penalty, thinks dropping the mandate would make premiums go up because fewer people would purchase plans, but said that most of the people she helps enroll would continue to buy insurance.

Several people Barker helped said they would stop buying and take the chance they wouldn’t need expensive care, she said.

“I don’t care what anybody says, it really does make people get insurance. Nobody wants a tax penalty. People don’t like that word,” Barker said. “People are willing to take their chances. They know they can always fall back to their old ways of using the ER as their primary care physician.”

The uncertainty over the future of the mandate and whether similar numbers of people would buy insurance influenced the 2018 premiums in Tennessee.

BlueCross BlueShield of Tennessee, for instance, attributed 7 percent of its average 21 percent premium increase to the questions surrounding the mandate and enrollment. For the first time, it predicated its increase on federal uncertainty, not care costs.

The costs are in the details, and people are paying more attention    

People are starting to dig into how much insurance is going to cost them over the course of the year, rather than focusing on the premiums.

Shoppers are more inquisitive and strategic this year as they examine their overall cost, with a spike in interest about whether urgent care clinics are covered, Barker said.

Barker and Shrago said their appointments are running longer because people have more questions about how plans would function in worst-case scenarios. Barker is calling insurers more frequently with specific, detailed questions people have.

Shrago said she's encountered several people who learned the hard way about misusing their networks when they got surprisingly big bills. 

Now that the exchange is a few years old, people have a better understanding of what they are looking for in a plan and how to use it.

Low premiums don't equal low cost. People gravitate toward middle-of-the-road plans.  

High deductibles, which are rising for those who have employer-sponsored plans and those who buy their own plans, are factors in what people are buying.

Many people who are tax credit eligible can find premiums close to zero dollars per month for bronze insurance plans because of the way the subsidies are assessed.

Insurers raised prices on silver plans because of cost-sharing reduction (CSR) uncertainty, and a silver plan is the benchmark for subsidies. So, if it went up in price at a higher percentage then the bigger tax credit will apply across plan types.

Bronze deductibles can top $7,000, giving shoppers sticker shock, Barker said.

But even though there’s an Oscar Health bronze plan with a $3,500 deductible that after tax credit is $5 or less for many people — even those under age 40 — most people, Shrago said, are still opting for silver plans, which offer more plush coverage.

“I can’t say I’ve enrolled anybody in a bronze yet. I haven’t sold a gold either,” said Barker, who has helped 50 to 60 people pick a plan so far.

Not everyone qualifies for subsidies, and those are the people who get walloped by the full extent of increases year after year.

There’s not a clear path in what they choose to do, Shrago said. They think about bronze plans and want to know about off-market plans that don’t qualify for tax credits, whether to go without or how health savings accounts work.

“There’s just more to understand,” Shrago said.

Reach Holly Fletcher at hfletcher@tennessean.com or 615-259-8287 and on Twitter @hollyfletcher.

Overwhelmed by options?

Get Covered Tennessee has free resources in every county to help people pick an insurance plan. 

To find an enrollment event or schedule an appointment go to getcoveredtenn.org or call 1-844-644-5443. 

There are enrollment events in Nashville every day at public library branches or community centers until the season ends Dec. 15. 

Saturday events on Nov. 18, Dec. 2 and Dec. 9:

• Downtown Library: 615 Church St., Nashville, TN 37219: 10 a.m. to 4 p.m.
• Southeast Library: 5260 Hickory Hollow Parkway #201, Antioch, TN 10 a.m. to 4 p.m.