Consumers who buy insurance through the Affordable Care Act markets may be pleasantly surprised this fall as average premiums are forecast to rise much less than in recent years.
The price of a 2019 policy sold on the ACA exchanges will increase less than 4 percent according to an analysis of preliminary filings from insurers in all 50 states by ACASignups.net, a web site and blog run by analyst Charles Gaba that tracks ACA enrollment and insurer participation.
And those insurers are expanding their offerings.
"The news about the marketplace this year is very good, both in terms of the premium increase and extent of carrier participation," says Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation. (The Foundation supports NPR's health care coverage.)
She says premiums overall are rising at about the same rates as medical inflation. Which is a big change from the last few years when prices rose in the double digits.
For example, the cost of a "bronze" policy, which is intended to cover about 60 percent of a person's health costs, rose 17 percent from 2017 to 2018. And the cost of the more popular, and more generous, silver plan, rose 32 percent in the same timeframe.
"We're seeing that double digit kinds of increases are occurring in a small handful of states, but they're definitely the exceptions," says Hempstead.
For example, premium prices in Kentucky and Connecticut are both forecast to rise an average 12 percent, according to ACASignups.net.
"In quite a few states, we're actually seeing premiums going down," she says.
In New Hampshire, prices are expected to fall about 13 percent, and in Tennessee they could drop 11 percent, according to the analysis.
Insurance companies are also expanding into new markets, says Hempstead who has been tracking what policies companies plan to offer in various counties.
In Pennsylvania, four companies – Geisinger, UPMC, Capital Blue Cross and Highmark – are expanding their coverage footprints.
The upstart health insurer, Oscar, which got into the insurance business specifically to serve ACA markets, is expanding to Florida, Michigan, and Arizona.
The Wellmark, which abandoned the ACA market in Iowa last year, is returning.
Hempstead says the increased offerings are a sign that the market is maturing.
"After a very ... tortured birth and infancy, it sort of seems like the market is in some ways at a very stable place right now," she says.
She says insurance companies have figured out how to make a profit from the policies they sell on the ACA exchanges.
But the news could be better, Gaba says.
Premiums would actually be falling next year but for the actions of the Trump Administration and Republicans in Congress that have weakened the ACA law itself and its markets, Gaba says.
Those actions include getting rid of the tax penalty for people who don't buy health insurance, refusing to reimburse insurance companies for discounts they are required by law to offer to low-income customer, and encouraging insurers to sell stripped-down, short-term insurance. Those moves are draining healthy young people out of the ACA market.
"The reality is that if you didn't have those factors, if you didn't have the expansion of a short term plans, and especially the repeal of the mandate penalty for next year, average premiums would most likely be dropping by a good four or five percent," he says.
Gaba says some states have managed to lower their premiums by adding a state-level individual mandate requiring people to buy health insurance or implementing a reinsurance program that limits the amount of high-priced medical care an insurer will have to pay for.
Whether premiums go up or down, consumers who qualify for a subsidy will likely pay about the same for their insurance next year as they're paying now. Subsidies are available to people who earn less than 400 percent of the federal poverty level, which is $24,600 for a family of four this year.
Open enrollment for 2019 on the Federal exchange and in most states begins on Nov. 1 this year.
DAVID GREENE, HOST:
Syrian refugees who are in Lebanon need all the help they can get. But now they're getting it from a group of anti-immigration extremists from Germany. This group's help comes with a catch. For them, it's part of an effort to keep Muslims out of Europe. NPR's Ruth Sherlock reports from Lebanon's Bekaa Valley where she went to meet some refugees.
RUTH SHERLOCK, BYLINE: Raja and her family are refugees from Syria. She's afraid to give her last name but invites us into her simple home next to some tents where other refugees live.
RAJA: (Speaking Arabic).
SHERLOCK: Over coffee, she tells us about the two young German men who arrived at her door some months ago. They told her they were researchers for a charity.
RAJA: (Through interpreter) They seemed fine. They just wanted to come in and film the house. We said we have nothing to hide. They filmed everything, even the kitchen.
SHERLOCK: The men are actually connected to a far-right group in Germany that calls itself the Identitarian Movement. It wants to stop families like Raja's from coming to Europe.
RAJA: (Speaking Arabic).
SHERLOCK: She says she wouldn't have let them in if she'd known. Her sister-in-law, Mouna, says she'd like to beat them up.
MOUNA: (Speaking Arabic, laughter).
(SOUNDBITE OF MUSIC)
SHERLOCK: The men used the footage of children in Raja's home in a slick new video they posted online to pitch their new plan - give aid in Lebanon to stop refugees coming to Europe.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED PERSON: (Speaking German).
SHERLOCK: They call the effort the Alternative Help Association, or AHA. Sven Engeser is in the Identitarian Movement, a leader of AHA and one of the men who came to Raja's home. He says they told people they were a relief organization focused on local help. Now back in Germany, I reach him by Skype.
SVEN ENGESER: We want to save our borders because of the mass immigration to Europe. I think we lost our identity.
SHERLOCK: He rejects the label far-right. He says he's a, quote, "patriot," which to him means stopping immigrants, especially Muslims, migrating to Europe.
ENGESER: We want to stop Muslim migration to Europe and to stop support them in Germany. It's a problem because it's not easy to integrate them, and Europe is a Christian continent.
SHERLOCK: Simone Rafael is from the Amadeu Antonio Stiftung, a Berlin-based group that researches extremist movements. She says though the Identitarians try to cloak it, they are part of Germany's far-right.
SIMONE RAFAEL: What they really want is that these ideas are main principles for the whole society in Germany, which they aren't. And so they try to hide their intentions to gain more influence.
SHERLOCK: She says they promote racism and are so Islamophobic that they don't even consider Muslim citizens Germans. Rafael says authorities are watching the group, worried that though it may number just a few hundred, it has extremist connections and a growing reach on social media. And German aid organizations have warned their partners in Lebanon to steer clear of AHA.
TILL KUSTER: What they do is they misuse the need of refugees in Lebanon for their political goals.
SHERLOCK: Till Kuster from the German nonprofit Medico International believes AHA is largely an exercise to win the group more support in Germany. There are lots of other groups, including the United Nations, spending hundreds of millions on Syrians in Lebanon. Right now, AHA admits it's only raised enough funds to pay the rent for 10 refugee families. For some, that's around a hundred dollars a month to live in a tent. Um Mahmoud is one of the recipients who also asks not to use her full name.
UM MAHMOUD: (Speaking Arabic).
SHERLOCK: She's a widow and lives with her disabled daughter in a basic tent. In the summer heat, it's stifling inside.
It's too hot, isn't it?
MAHMOUD: (Speaking Arabic).
SHERLOCK: Um Mahmoud says the rent payment isn't enough to keep her in Lebanon. She'd still go to Europe if she could. I ask her which country she wants to go to.
MAHMOUD: (Speaking Arabic).
SHERLOCK: "Germany," she replies. "Isn't that the best?" Ruth Sherlock, NPR News, the Bekaa Valley, Lebanon. Transcript provided by NPR, Copyright NPR.