“feet dragging” and “nightmarish”

These are words used repeatedly to describe the lack of response and guidance on proclamations made by President Trump over the last many months about changes to the Affordable Care Act. And time is running out for this year.

We do know that in California, Open Enrollment will start November 1, 2017 and run through January 31, 2018.  Open enrollment is the time when individuals can enroll in coverage for the first time or change plans for the 2018 plan year. If you enroll by December 15th, coverage can start January 1, 2018. (Enroll by Jan 15th for Feb 1 start date and by January 31 for March 1 start date).

Carriers have been preparing. Anthem Blue Cross announced last month that they will be leaving the market in most CA counties. Most other carriers have prepared two sets of rates for 2018, one for business as usual and the other if the White House follows through with threats to pull federal subsidies and allow for waivers. In both cases, there will be increases with the latter being greater. California, having one of the more successful state-run marketplaces (CoveredCA), is in a better position than most states. California’s active private market (that offers more plan options, a streamlined enrollment process but no subsidies), will offer two PPO plans in addition to multiple HMO’s  in most counties.

With the delay and uncertainty mentioned above we do not expect carriers to release approved rates before open enrollment begins. Quoting services like the one we use, are gearing up to have all rates and plan information verified and ready for comparisons and release November 1, 2018.

We of course will once again be helping clients and your referrals with their health insurance decisions this open enrollment season. Feel free to visit our web site for quotes and information. OnlyHealthInsurance

Phone appointments with me can also be scheduled using my online scheduler: Make Appointment with Phil

Thank you.

Phil Dougherty


Anthem Blue Cross to all but leave the individual market in CA

Anthem Blue Cross has announced that they will offer Individual/Family plans in three regions of Northern California only next year, which will include most upper northern counties, Santa Clara County, and the Stockton/Modesto area.  Anthem BC will continue to offer their EPO product in these areas. Members outside of these areas will have their existing coverage through the end of this calendar year. Enrollment in new coverage from a new carrier can take place during the open enrollment period (Nov 1 through Dec. 15) with coverage starting January 1. This affects both on-exchange (CoveredCA) and off-exchange market plans.

This does NOT affect Medicare Supplements, Medicaid, employer based plans, and Grandfathered plans (plans in effect prior to 2010).

So why the exit? Too risky. The instability of the marketplace, the shrinking Individual market, and heavy regulatory environment makes pricing plans with any confidence impossible. They will leave it to others and wait for workable changes from Washington.

Phil Dougherty

ACA & State Reform Update

ACA UPDATE 6/28/2017

The Better Care Reconciliation Act (BCRA), the ACA replacement bill put forth by Senate Republican leadership, is short the necessary votes to pass this month (June), so they will attempt to schedule a vote following the July 4th recess provided they can rally defiant Republicans to support the bill.

The BCRA bill mirrors a House bill in a number of ways, but there are several key differences also. Even if it passes the Senate, it must pass the House first before going to the President for signature. The House could pass it as is, or negotiate a new compromise bill.

Although the specific timing to complete this process is unclear, both Congress and the Administration continue to be focused on the repeal and replacement of the ACA.

For those concerned about immediate changes, the BCRA includes a transition period of several years before some provisions go into effect and others sunset. And not all ACA provisions are impacted by the BCRA bill.

In short, the BCRA would repeal the individual and employer mandate and penalties, end some Medicaid funding, repeal most ACA fees and taxes and maintain some protections for pre-existing conditions. For more details, read this recent Kaiser Foundation update:

Summary of BCRA

California State Reform Measures

Effective July 1, 2017,  bipartisan legislation will go into effect barring “balance billing” from non-participating providers when being treated in In-network facilities. This limits a patient’s cost-sharing responsibility for services rendered from out-of-network providers at an in-network facility, to the amount the patient would have paid to an in-network provider and counts the cost-sharing amount toward the individual’s deductible and out of pocket limit.

A good example of this, and one many of my clients have faced through the years, is when a patient uses an in-network hospital or clinic, and unbeknownst to them, are treated by an out-of-network provider (one who does not contract with the insurer), such as an emergency physician,  second surgeon, radiologist or anesthesiologist. This consumer protection bill is intend to protect health care consumers from these surprise bills. Some welcome legislation.

California Single Payer

The state’s Single Payer initiative will remain “in committee” until further notice. There is still plenty of passion and support for such a solution, but the bill lacks specifics on funding, delivery of care and cost controls. But, it did what many believe it was meant to do: start the discussion and build on the momentum. The goal now among its supporters is to get it on the ballot for November 2018.

More updates to come. Stay tuned.

Phil Dougherty



Everything on the Table

In my reading of daily news from various sources, it is clear we are no closer to a solution on healthcare than we were three months ago. Here are just a handful of recent headlines:

Senate Republicans continue work on ACA replacement

Time may be running out on Senate Obamacare talks

Ideas emerge as Senate debates health care

Trump Seeks Delay of Ruling on Health Law Subsidies, Prolonging Uncertainty

Senators explore options for pre-existing conditions

The most interesting headline is what’s happening right here in CA:

Calif. single-payer health care bill would cost $400B, analysis finds

A current bill in the CA legislature (SB562) would remove insurance companies from healthcare delivery and provide 100% coverage for all legal and illegal residents (including Medicare recipients, Medi-Cal recipients, employer based insurance participants, enrollees in CoveredCA and private insurance plans). All public funds currently utilized on healthcare (Medicare, Medi-Cal, CoveredCA subsidies) would be used to cover half of the $400 billion estimate with the other 50% coming from employer and personal tax increases.

Gov. Jerry Brown has concerns and the bill would need Washington’s (Trump) approval in releasing federal funds to such a program. California loves to be first and you can bet other states will see how this progresses.

The longer it takes for an Obamacare “fix”,  the greater success single payer initiatives will have in gaining followers.

Stay Tuned.

Phil Dougherty




UP A Creek?

Despite the fact that the first round of “Repeal and Replace” fizzled, a significant change is coming. In early April, the new administration announced that it would cut back the enrollment period for next year’s individual plans offered through the existing Affordable Care Act exchanges.

Previously the annual open enrollment period was from November 1 through January 31. The adjusted period will run from November 1 through December 15; a month and a half shorter. The administration has been quiet on important questions concerning the continuation of premium and cost sharing reduction subsidies and the insurance mandate and penalties, creating some uncertainty in the marketplace.

This indecision and the shortened enrollment period will make it difficult for carriers to prepare and price their plans for 2018. Some have threatened to withdraw from markets or the ACA entirely unless they receive some clear regulatory guidance. This could send the ACA up a creek without a paddle.  Stay tuned.


ACA and the Trump Administration

We have received numerous inquiries from clients as to the fate of their health insurance. We know that President Trump has signed an Executive Order and that change to the law is inevitable. Here are a few reminders and thoughts on what to expect:

  • The ACA is still the law. Even though change is expected, the ACA remains in place and unchanged at this time. The law still requires most Americans to have health insurance to avoid tax penalties.
  • Open Enrollment continues through January 31. There’s still time for individuals and families to enroll in coverage for 2017. You can purchase coverage through the private market through a broker like me, or enroll via Covered California, the public marketplace.
  • Whatever changes come, they’ll take time. Changes will require specific legislative and administrative action. Health policy experts predict that consumers will be given a transition period while Congress puts together any replacement plan.

We’ll keep you posted on important news and updates that directly affect your health insurance. Thanks, Phil