In Search of Certainty: An Update on the Exchanges

On November 1, 2017, the fifth open enrollment period will begin for the Health Insurance Exchanges (Exchanges) created by the Patient Protection and Affordable Care Act (PPACA). For the second year in a row the Exchanges are facing large premium increases and decreased insurer participation. These challenges can be traced to a number of factors, but perhaps the largest change in the last 12 months has been the change in Administrations that ushered in federal leadership that made PPACA’s repeal a political priority and signaled the Trump Administration’s belief that the law is failing. Although it appears that political efforts at full PPACA repeal are on hold for the moment, the Exchanges still face an uncertain regulatory and funding environment. This uncertainty is unlikely to be resolved in time to affect 2018 plan offerings, since insurers had to finalize Exchange rates for the 2018 benefit year by September 25^th and had to sign Exchange participation agreements by September 27^th. Decisions made by Congress, state governments, and federal and state regulators in the coming months will, however, affect whether the current challenges persist as business planning begins for the 2019 benefit year.