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State officials: No premium increase for most under Affordable Care Act in 2020

Donna Vargas, a health advocacy coordinator with the

Donna Vargas, a health advocacy coordinator with the Health and Welfare Council of Long Island, helps client Michael Reyes, 21, of Huntington Station, navigate the application process for health insurance through the Affordable Care Act on Thursday. Credit: Newsday/John Praskevas

All but a few New Yorkers enrolling for 2020 coverage under the Affordable Care Act will not see an increase in their premiums, state officials said.

Enrollment in the state health insurance marketplace begins Friday. Only those who earn too much money to qualify for subsidies under the law — more than $103,000 a year for a family of four — will see increases in premiums, said Danielle Holahan, deputy director of the state’s marketplace, New York State of Health. Those people, who comprise less than 2% of New Yorkers who receive coverage under the law, will see an average 6.8% increase, she said.

The new enrollment comes as the Trump administration is asking a federal appeals court in New Orleans to declare the ACA — commonly known as Obamacare — unconstitutional. Trump ran in 2016 on a promise to repeal the law, but efforts in Congress to do so have failed. Even so, the Trump administration slashed funding to promote ACA enrollment.

New York, on the other hand, will spend $43 million on promotion for 2020 and on “navigators,” who help people apply for coverage, under the ACA, Medicaid or Child Health Plus, the state’s insurance program for children.

“We’re more committed than ever, with all these attacks from Washington on the ACA,” Holahan said.

Navigator Donna Vargas, with the Melville-based Health and Welfare Council of Long Island, said many people have little knowledge about subsidies.

“I try to evaluate their situation, their household size and their income, and we try to find out what programs they’re eligible for,” she said as she sat with a client Thursday at the Family Service League’s Manor Field Family Center in Huntington Station.

The client, Michael Reyes, 21, of Huntington Station, said he was there in part to seek coverage for his son, Matheo, 2. Vargas enrolled Matheo on the spot in Child Health Plus.

Health care premiums are on a sliding scale. For example, according to the state:

  • A Long Islander with an annual income of $30,000 could obtain individual insurance for as little as $25 a month for a high-deductible plan, or for as little as $198 a month for a plan with lower deductibles.
  • A Long Island family of four with an annual income of $75,000 would be eligible for coverage under the ACA and Child Health Plus. The parents would pay as little as $249 a month for a high-deductible ACA plan for themselves and as little as $596 a month for a plan with lower deductibles. Monthly premiums would be $30 for each child.
  • People with incomes up to $18,735 for an individual and $38,625 for a family of four are eligible for free coverage under Medicaid or with the “essential plan” under the ACA.

New York is one of only two states with an “essential plan,” which is for people with relatively low incomes but who earn too much to qualify for Medicaid, Holahan said. They pay either no premiums or, for those who earn up to $51,500 a year for a family of four, $20 monthly premiums.

The “essential plan” is key because some people who can afford premiums under lower-cost ACA insurance cannot afford the high deductibles and copays, said Dr. Arthur Fougner, president of the Westbury-based Medical Society of the State of New York and a Manhasset OB-GYN. The essential plan has no annual deductibles.

The stabilization of ACA premiums statewide and nationally came after a spike in premiums some years as insurers figured out who was enrolling in ACA plans, and their risk levels, said Sara Collins, a vice president at the Commonwealth Fund, a Manhattan-based health care foundation. With that experience, “What is likely going to happen over the next several years is premiums will rise at the rate of health care cost inflation,” she said.

Yet the Trump administration’s efforts to overturn the ACA and the national rhetoric against the law is confusing some people who may be eligible for ACA subsidies, said Rebecca Sanin, president and CEO of the Health and Welfare Council. Some may not apply, thinking the program is dead or dying. Others currently with ACA coverage may fear the program is ending, “And they will start thinking about rationing their medications so they last longer,” she said.

AFFORDABLE CARE ACT

Affordable Care Act open enrollment begins Friday. It continues until Dec. 15 for those who want coverage beginning Jan. 1 and until Jan. 31 for those who want coverage beginning March 1.

Subsidies are available to many applicants, based on income and household size. Some people are eligible for free coverage.

To find out more about monthly premiums and what programs and subsidies you may be eligible for, go to nystateofhealth.ny.gov or call 855-355-5777.

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