President Trump cuts subsidies for some Obamacare participants

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President Donald Trump announced he plans to end a set of subsidies that help low-income enrollees in Affordable Health Care marketplace health plans. We talk about what impact his move might have on those in Arizona participating in those health care plans. Greg Vigdor, president and CEO of the Arizona Hospital and Healthcare Association, talks about the cuts in subsidies along with Dr. Daniel Derksen, a Public Health Care Policy professor at the University of Arizona.

Ted Simons: Coming up next on "Arizona horizon," how cuts to Obamacare subsidies might affect health-care in Arizona. Also tonight, a white house correspondent talks about covering the Trump administration, and why people choose to adopt pets from animal "shelters." those stories next, on "Arizona horizon."

"Arizona horizon" is made possible by contributions by the friends of Arizona PBS, members of your pbs station. Thank you.

Ted Simons: Good evening and welcome to "Arizona horizon." I’m ted Simons. President trump's ending of subsidies that helped low-income consumers in the affordable health care marketplace could mean further instability in health-care exchanges like the one set up here in Arizona. Here to talk more about this is Greg vigor, president and CEO of the Arizona hospital and healthcare association, along with dr. Daniel derksen, a public health-care-policy professor at the university of Arizona. Good to have you both here.

Greg Vigdor: Good to be here.

Ted Simons: What exactly did the president do?

Greg Vigdor: The president stopped payments being made to insurance companies to help them shore up commitments to low-income people in terms of premium payments. The payments were found in how congress had done it. They were challenged in court. They were making payments but he announced they would stop doing that so the coverage is now gone.

Ted Simons: When you say lower income, what are we talking about?

Greg Vigdor: In general, the subsidies trying to capture folks that couldn't get insurance so it was going to health plans.

Ted Simons: They are at the bottom of the ladder, making too much not enough.

Daniel Derksen: It affects 100% of the poverty level, $12,000 per individual to 250% of the federal poverty level. The individuals covered aren't effected. This is a decrease of $7 billion a year to insurance companies. The insurance companies have to make it affordable for the low-income individuals to be covered.

Ted Simons: With that in mind, what happens to premiums?

Daniel Derksen: They'll increase the premiums. Arizona insurers built this into their proposal so we don't expect big jumps in premiums from the Arizona insurers.

Ted Simons: Blue cross, blue shield, Maricopa counties, because they anticipated this and built the increases in -- we understand they are pretty stable right now.

Daniel Derksen: They have done well. Last year we saw a big jump, a doubling in premiums. With the increase and building in to their calculations this year, having no cost-sharing reductions from the federal government moving their way, I think Arizonans will be fine.

Ted Simons: Insurance companies also the president making sure insurance companies can offer less comprehensive plans. It's not required to cover xyz.

Greg Vigdor: It's another policy proposal without detail. The president has proposed, asked cabinet directors to come up with policy proposals to allow insurance to be sold across state lines and association health plans, different groupings of parties to come together. How this works, nobody knows. There is no detail and the details matter on these matters.

Ted Simons: You need federal rules for this, don't you?

Greg Vigdor: Ted Simons: Absolutely and some will be challenged in court.

You mentioned going across state lines. Doesn't the affordable care act do that?

Greg Vigdor: There are provisions to sell across state lines. Virtually, no one has tried this. There is a question mark about who will go for this offering.

Ted Simons: This sounds half-baked. When it's fully baked, at what point does it become effective?

Daniel Derksen: We'll see down the road if it goes through and the challenges in court. There are 19 states joining up for litigation against the cost-sharing reductions in place now. Down the road, we could see a further decrease in the number of insurers in rural areas. In Arizona, we have single payer, one insurer in 13 counties, blue cross blue shield. There may be counties this year with no insured plans. That's of great concern in rural areas and rural Americans will be affected if they can't access health insurance they need.

Ted Simons: How disruptive is it overall to the health insurance market?

Greg Vigdor: It's unsettling when people hear the stories. There is uncertainty about legislation. It's simpler than that. Right now, Arizonans have an opportunity, individuals and families to buy flat rates for the coming year. Cover is a website to do that. That's what people should focus on. What they can do for themselves and their families.

Ted Simons: When they do that, is it grandfathered down the road or do we know that?

Greg Vigdor: I think it's covered. Once they sign up, what they have is what they get for another year.

Ted Simons: What we are talking about here, in general overall what happens to the number of uninsured and what happens with regard to the cost of premiums?

Daniel Derksen: I think Arizona is successful in reducing uninsured. We have uninsured provisions through Medicaid and the marketplace. We have 700,000 uninsured Arizonans. It's still to me as a family physician, unacceptably high. We should reduce the uninsured, not go in the opposite direction adding more to the roles. That drives up uncompensated charity care making it difficult for the hospitals across the state.

Ted Simons: The hospitals must be saying, someone make a decision. Let's move forward.

Greg Vigdor: We are but we were troubled with the proposals around Medicaid. As Medicaid go so goes Arizona’s healthcare. We are concerned about that. Let's not forget Medicare.

Ted Simons: There were attempts to change that. They have failed. In the past, nothing happened.

Daniel Derksen: I think what's important is what Greg was talking about. We have 140,000 Arizonans enrolled and paying premiums right now. This year's open enrollment period was halved from last year. I hope people are not confused by the discussion. Come December 1st, when your letter comes to renew, make sure you get what you need. We have navigators to assist and answer questions about what people are eligible for and if they need assistance, getting them enrolled.

Ted Simons: Thank you for being here. Coming up on "Arizona Horizon," a conversation with white house correspondent Jon decker.

Greg Vigdor, President and CEO, Arizona Hospital and Healthcare Association
Daniel Derksen, M.D., Public Health Care Policy Professor at University of Arizona

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