The Delaware Health Insurance Marketplace will see rate hikes of up to 34.98% after federal funding cuts and policy changes.
Marketplace enrollment under the Affordable Care Act hit an all-time high in Delaware last February at just over 50,000, with 92% using Advance Premium Tax Credits that bring premiums down more than $500 a month.
But those credits will expire at the end of the year without further action at the federal level.
Delaware Insurance Commissioner Trinidad Navarro said that means the 50,000 Delawareans covered could see rate increases of more than 30%.
“This is sort of history repeating itself when the current administration tried to kill the ACA through 1000 paper cuts several years ago,” Navarro said. “And unfortunately, due to what's happening with the federal budget activity, changes to the Marketplace rules and, really, most importantly, the expiration of the Advanced Premium Tax Credits – the perfect storm.”
Navarro noted changes to the marketplace do not include Medicare, Medicaid or policies purchased outside of healthcare.gov.
He added his fear is Delaware will see more people risk being uninsured, which would push more people to hospitals and urgent care rather than primary care physicians.
In recent years, the state’s marketplace expanded the number of plans available. Plans from AmeriHealth Caritas will increase an average of 34.98%; Highmark plans will increase an average of 25%. Highmark has a catastrophic plan that includes three primary care visits.
Celtic Ambetter Health of Delaware will increase an average of 31.8% after threatening to leave the state’s Marketplace if that demand was not met. The Delaware Department of Insurance negotiates with providers on rate increases and was not able to get CAHD providers to lower that number.
Navarro said the lion’s share of these increases are because of federal changes, such as 90% funding cuts for Marketplace navigators and new enrollment rules that make coverage more costly.
“All these things are happening at a time last year, we had the highest number of residents insured on the ACA in our history,” Navarro said. “And I'm just fearful that that's going to take a significant drop because of these changes.”
Just under 45 thousand people enrolled on the Delaware Health Insurance Marketplace last year with a 29% increase from 2023. That was up 77% from 2021.
That’s largely due to the increased variety of plans offered by four companies in the Marketplace. Policyholders can choose between more than 50 plans. Cost for all plans is expected to increase without a federal change.
Navarro added the cost of care in Delaware is already high and state officials are working on ways to make health care more affordable, including addressing the shortage of physicians and nurses.
“That's why we worked on a number of initiatives here in Delaware, [...] where we were trying to reimburse primary care docs at a higher rate so that we keep them viable,” Navarro explained.
Many doctors in the state are converting to concierge services or going to work for hospitals rather than private practices.
“We have a program that ensures that Delaware folks who want to become physicians can go to the facilities in Pennsylvania,” Navarro said. “We have a number of slots that the State of Delaware actually pays for the slots... So we're trying on a number of different fronts, but we're behind.”
Navarro said he worries that the checks and balances in place in the Trump administration’s first are no longer enough.
“My heart is not to sound political and not to point fingers, but I mean, it's in black and white,” Navarro said.
Insurers have to use 80% of their profit on patients and policy holders. The remaining 20% can go to advertising, other costs or profit, according to Navarro.
