“When premiums rise a lot, a lot more people become eligible for subsidies,” said Matthew Fiedler, a fellow at the U.S.C.-Brookings Schaeffer Initiative for Health Policy, who was an economic adviser in the Obama administration.
In a news release, the Trump administration emphasized rising prices as an explanation for the dip in enrollment among higher-earning customers.
“These reports show that the high-price plans on the individual market are unaffordable and forcing unsubsidized middle-class consumers to drop coverage,” Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said in a written statement.
But the administration has taken actions that are likely to raise prices still higher for comprehensive health insurance, making the markets even less stable. Besides slashing its budget for Obamacare advertising and enrollment assistance last year, the administration eliminated payments to insurance companies meant to help offset the cost of covering their lowest-income customers.
It has enacted additional policies, going into effect by next year, that could weaken the Obamacare markets. In January, people who fail to obtain health insurance will no longer need to pay a fine. The administration recently released a rule allowing more self-employed Americans to buy so-called association health plans, which are not subject to as many rules as Obamacare plans.
Another rule, to let individuals buy “short-term limited duration” insurance, which can include fewer benefits and can reject people with a history of illness, is expected to be made final soon. The administration has described the coming insurance options as a lifeline for middle-class customers slammed by price increases in the Obamacare markets.
But they will be useful only for people who are healthy enough to qualify for the new plans. Taken together, the new plans and the repeal of the fine will tend to draw healthier customers out of the markets, raising prices for those who remain. According to the Congressional Budget Office, the combined policies will raise insurance prices by more than 10 percent.