HEALTHCARE; Congressional Record Vol. 163, No. 178
(Senate - November 02, 2017)

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[Pages S6997-S6998]
From the Congressional Record Online through the Government Publishing Office []


  Mr. ALEXANDER. Mr. President, I ask unanimous consent to have printed 
in the Record a copy of the article, ``More ACA Plans to Come With No 
Premiums in 2018,'' by Anna Wilde Mathews and Christopher Weaver that 
was published in the Wall Street Journal on October 27, 2017.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

            More ACA Plans To Come With No Premiums in 2018

       Insurers selling Affordable Care Act plans have a 
     compelling new pitch: free health insurance.
       When sales of plans on the law's exchanges begin Nov. 1, a 
     growing number of consumers around the country will be able 
     to get coverage for 2018 without paying any monthly premium, 
     according to health insurers and an analysis of newly 
     available federal data.
       In nearly all of the 2,722 counties included in the data, 
     some consumers will be able to obtain free health insurance 
     because they qualify for larger federal premium subsidies 
     that cover the full cost of a plan, according to the new 
       The growing availability of no-premium plans is a side 
     effect of a decision by President Donald Trump's 
     administration to end federal payments that are used to 
     reduce out-of-pocket costs, such as deductibles, for low-
     income enrollees. The administration didn't halt--and 
     indirectly bolstered--the federal subsidies that help 
     consumers with their insurance premiums.
       The new analysis doesn't project exactly how many consumers 
     could be eligible for the no-premium plans, a figure that 
     depends on variables including people's income, household 
     size, age, location and access to other types of health 
       In the coming weeks, insurers are gearing up to promote the 
     no-premium option. Amid uncertainty about the future of the 
     2010 health law, known as Obamacare, many insurers have 
     pulled back from the law's marketplaces. Many of the 
     remaining ones are worried about losing enrollment next 
     year--largely among consumers who aren't eligible for 
     subsidies and won't be able to get premium-free plans.
       Insurers hope the no-premium insurance draws in more 
     enrollees, particularly those they need most: people with few 
     health needs. Healthy consumers help bolster the stability of 
     the market by balancing out the health costs of sicker 
       ``We absolutely will be promoting this opportunity to get 
     coverage at a zero price,''

[[Page S6998]]

     said Wendy Curran, a spokeswoman for Blue Cross Blue Shield 
     of Wyoming, which is mentioning the no-premium plans in 
     print, radio and social-media advertising. ``We hope those 
     younger people will say, `Well yeah, if it's not going to 
     cost me anything, sure.' ''
       Ms. Curran said it was ``astounding even to us'' how many 
     people will be able to get no-premium insurance in Wyoming.
       The no-premium plans will also receive a hefty promotional 
     push from insurance agents. EHealth Inc. and HealthMarkets 
     Inc., both big national agencies, said they're preparing to 
     highlight the option in advertising and other outreach.
       ``It's just the idea of something free being really 
     appealing,'' said Nate Purpura, a vice president at eHealth. 
     The company's surveys have consistently shown that price is 
     the most important factor in consumers' choice of plan, he 
       Availability will vary by age and income, but some 
     enrollees who don't have a very low income may be able to 
     land zero-premium coverage, according to the analysis of 
     federal data conducted by consulting firm Oliver Wyman, a 
     unit of Marsh & McLennan.
       The firm found that zero-premium ACA exchange plans would 
     be available next year to at least some consumers in a total 
     of 2,692 counties, out of 2,722 in the study.
       A 60-year-old making about $36,000 a year could find free 
     2018 plans in 1,590 counties, while one with income of about 
     $48,000 could do so in 654 counties, according to the 
     analysis, which used data released Wednesday for plans 
     available on, the federal marketplace used by 
     39 states.
       For 2017, no-premium plans were available in many places 
     for the very lowest-income enrollees, but for those at 
     slightly higher levels, they were much more scarce. For 
     instance, in 2017, a 60-year-old making about $36,000 could 
     find free plans in about 300 of the counties.
       That is what is different in 2018, said Kurt Giesa, a 
     partner at Oliver Wyman. The zero-premium plans are ``much 
     more prevalent now than they were,'' he said.
       In California, which isn't included in the federal data, 
     consumers must pay a minimal $1 a month. But there is a 
     ``huge increase from last year'' in the number of people who 
     will be able to buy virtually free plans, said Peter V. Lee, 
     executive director of Covered California, the state's ACA 
     exchange. Covered California currently has about 1.1 million 
     enrollees who receive federal-premium subsidies, and more 
     than half of them will be able to buy a plan for $1 for 2018, 
     he said.
       The growing availability of no-premium plans is tied to the 
     complicated dynamics of the 2010 health law, as well as a 
     recent move by the GOP president.
       Under the law's rules, subsidies that help pay for premiums 
     are available to people making up to about $48,000 a year. 
     Those subsidy amounts are linked to the cost of the second-
     cheapest silver plan in an enrollee's location. So, when 
     silver premiums go up, subsidies go up.
       Earlier this month, Mr. Trump's administration cut off 
     federal payments to insurers for covering certain out-of-
     pocket costs for low-income enrollees in silver plans. In 
     response, insurers raised premiums on their 2018 policies 
     sharply to cover the extra expense, now coming out of their 
     pockets--and in many cases, they loaded the extra boost only 
     onto the silver plans.
       Because the separate premium subsidies, which Mr. Trump 
     didn't cut, are linked to silver-plan prices, those subsidies 
     are rising, too. In many states, the costs for cheaper bronze 
     plans are going up much less rapidly than silver plans, so 
     many more people will wind up being eligible for no-premium 
       On the flip side, those who don't get premium subsidies 
     under the 2010 law may be responsible for the full brunt of 
     steep rate increases, though they may be able to mitigate the 
     impact by staying away from silver plans.
       For those who can get free plans, the lure may be 
       Medica, an insurer that is offering exchange plans in 
     states including Iowa, Nebraska and Wisconsin, is running ads 
     in some places that say ``$0 premium plans for individuals 
     who qualify.'' It is also sending letters to some current 
     exchange enrollees with bronze plans, who are likely to be 
     enrolled with Medica in 2018, informing them that they can 
     stop paying premiums next year. ``That's a nice letter to 
     get,'' said Geoff Bartsh, a vice president at Medica.
       Jerry Dworak, chief executive of Montana Health Co-op, 
     said, ``of course we're hoping that'' young and healthy 
     enrollees flock to the no-premium plans.
       ``If they see that it's free, why not take it?,'' he said.
       Mr. Dworak said that a person making as much as $33,000 a 
     year could get one of his company's Idaho plans and pay no 
       The plans may attract more older consumers than younger 
     because premiums and subsidies rise with age, making free 
     plans more available to older people.
       And for some, the zero-premium plans won't actually be the 
     best deal, insurers and insurance agents say. The silver 
     plans could be cheaper overall for people who use much health 
     care, despite their higher premium costs, if these people are 
     eligible for the health law's cost sharing help.
       According to, for instance, a 40-year-old 
     man in Cheyenne, Wyo., who makes about $24,000 a year could 
     get a zero-premium bronze plan, but he could pay as much as 
     $6,650 over the course of 2018 in deductibles and other out-
     of-pocket charges. Or he could get a silver plan that would 
     cost him around $125 a month, but cap his out-of-pocket costs 
     at $2,450.
       ``There's this trade-off,'' said Michael Z. Stahl, a senior 
     vice president at HealthMarkets, who said the company's 
     agents will walk through the pros and cons with clients.