Stethoscope and cash

Fewer Virginians are buying health insurance on the Affordable Care Act marketplace for individuals as premiums have continued to increase, and even more people are expected to leave the marketplace as they have become eligible for Medicaid under the state’s expansion program, according to a report by the state Bureau of Insurance.

Enrollment in the individual marketplace is projected to reach an all-time low in 2019, when 262,800 people are expected to buy health insurance individually compared with 317,866 in 2018 and a peak in 2016 of 418,013, according to the report given to the General Assembly’s Health Insurance Reform Commission on Monday.

At the same time, average monthly premiums are expected to reach a high of $796.29 in 2019, more than double the average premium in 2016.

Meanwhile, the percentage of Virginians who remain uninsured has stayed about the same, at around 10 percent, since the Affordable Care Act went into effect in 2014, even as the percentage of people enrolled in Medicaid has increased from 9 percent in 2014 to 12 percent in 2018.

Since Medicaid expansion went into effect on Jan. 1, an additional 45,000 people insured through the individual marketplace have enrolled in Medicaid, most of whom were receiving subsidies for their coverage.

That number is expected to grow to 70,000 within the next three years, according to Julie Blauvelt, deputy commissioner of the life and health division of the Bureau of Insurance.

The drop in individual enrollment comes as Virginia gained national attention when Charlottesville had the highest individual marketplace premiums in the U.S. last year.

And though one new insurance carrier began offering plans on the individual market in 2019 and another is expected to join in 2020, nearly half of all cities and counties in the state have only one insurance carrier offering plans in their locality.

Forty-two percent of localities have two carriers, and 10 percent have three or four carriers.

Blauvelt said the morbidity rate of the individual market is likely to increase, as healthy people are less likely to buy a plan due to the high premiums and sicker people in need of insurance will remain with the plan.

People insured through the individual marketplace, however, account for only 4 percent of all Virginians. More than half of the state population is insured through an employer, and more than a quarter is insured through Medicaid and Medicare.

The majority of plans offered by employers are self-funded, meaning that the employer takes on the expense of the health plans, as opposed to an insurance carrier. More than 3 million Virginians are insured through self-funded plans, which are not subject to state laws.

Still, Blauvelt’s report concluded that the employer-based insurance market is steadily decreasing, down to 53 percent of Virginians in 2018 from 57 percent in 2013, as the percentage of people with public insurance is increasing.

The report also concluded that individual enrollment had peaked in the early years after the Affordable Care Act went into effect and had declined since then, but predicted that the market may become more competitive as more insurance carriers have shown interest in offering plans on the individual market.

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