The Trump administration's efforts to undermine the Affordable Care Act have health care advocates and insurers concerned that the open enrollment period will be one of chaos and confusion.
That's not true everywhere.
A dozen states operate their own health insurance marketplaces, maintaining control over advertising and the help they can offer consumers. That was expected to create a striking difference when open enrollment began Wednesday between those states and the others that rely on the federal marketplace, essentially creating a tale of two countries.
A couple months ago it was reported that consumers throughout Merced and Mariposa counties would see a rate increase for monthly premiums of 24 percent on average. Although people in Merced County aren’t expected to see spikes quite as high, according to Cesilia Leon, program manager for Merced County Human Services Agency.
Premium rates are increasing overall between 12 and 20 percent, Leon said. Silver plans will have the highest increases.
Although cost sharing reductions were eliminated by the federal government, Leon said, in anticipation, Covered California worked with insurance companies to minimize the increased cost.
Generally, the amount of financial assistance available to consumers will increase throughout Merced, Mariposa, Stanislaus, San Joaquin and Tulare counties, according to Covered California’s Health Insurance Companies and Plan Rates for 2018.
The main change in Merced County this enrollment period is Anthem Blue Cross reduced the number of plans offered, Leon said. This can result in people having to change their provider, she said, because the healthcare plan dictates the network of doctors people are able to go to.
For the individual health insurance market in much of the country, the Trump administration has slashed spending on advertising by 90 percent and drastically reduced budgets for the groups that help consumers choose a plan.
It cut the open enrollment period in half, to six weeks. Shortening the sign-up window further, the federal government will shut down its online marketplace, healthcare.gov, for 12 hours of maintenance nearly every Sunday during open enrollment.
The 12 states with their own exchanges are free to chart their own course and make it easier for consumers.
Nine states, including California, have extended open enrollment beyond Dec. 15 — by a week in some states and six weeks in others. In California, Leon said, people can enroll until Jan. 31.
They also can make their own decisions about spending because their budgets are free from Washington politics. State-run exchanges typically pay for their operations through fees charged to insurers on plans sold through their marketplace.
For many of these states, 2018 looks like a payoff for the political risks and costs they assumed when they decided to set up their own exchanges.
No state is totally immune from the spikes in insurance premiums since the health care overhaul launched in 2014.
Many states are bracing for double-digit rate hikes in the individual market, with an average increase of 12.5 percent in California.
Millions of shoppers, whether they buy coverage on HealthCare.gov or through their state's marketplace, will see another modest spike after Trump's decision earlier this month to halt payments to insurers that help cover some consumers' deductibles and co-pays. Trump called those cost-sharing payments "bailouts" to insurance companies.
The federal subsidy on actual premiums remains, but some state officials are concerned that consumers will be confused and believe those, too, have been eliminated. The worry is that they simply would not bother to shop for a plan, thinking they couldn't afford it. About 12 million Americans buy individual overage on the exchanges, according to the Kaiser Family Foundation.
The morning after Trump's Oct. 12 announcement, Colorado's Connect for Health exchange sent an email blast to current and prospective enrollees, stressing that "financial help is still available for 2018."
That's the kind of autonomy that gives states with an independent marketplace an upper-hand, said Larry Levitt of the nonpartisan Kaiser Family Foundation.
"That's where state-based exchanges are maybe in the best position to help stabilize markets, by just putting extra resources into educating consumers in a very confusing time," he said. "They have the ability to dial that up at times like this."
Amid the changes at the federal level, California is staying the course. As always, open enrollment on Covered California, the state marketplace, will run through January.
Its $66 million advertising budget is steady from last year — and more than six times the total that HealthCare.gov will spend in all 38 states it covers.
Peter Lee, Covered California's executive director, was perplexed by the Trump administration's decision to gut advertising spending. With premiums on the rise and confusion mounting, promotion and marketing are more critical than ever, he said.
"Health insurance needs to be sold. To walk away from selling it is a formula for increased costs," Lee said.
In Washington state, lawmakers set aside an extra $1.5 million to help their marketplace cut through the confusion.
The state's Healthplanfinder has added four enrollment centers — for a total of six — and is running digital and radio ads that promote the exchange as a beacon of stability amid the uncertainty in much of the rest of the nation.
Chief Marketing Officer Michael Marchand is grateful for Washington's independence from the federally run marketplace. That is particularly true when it comes to so-called navigators, the specialists who fan out across the state to help consumers study various plans and enroll.
State-based exchanges in Washington and elsewhere are maintaining their funding levels at a time when the federal government has slashed navigator grants from $63 million to $36 million.
"They have to play by the house rules," Marchand said of the states using the federal marketplace. "That's a difficult thing."
Merced Sun-Star’s Moncia Velez contributed to this report.