Report: Silver plan premiums increased by 32% on average in 2018, with wide state variations

Document titled, Affordable Care Act
Uncertainty and instability in the market are driving 2018 ACA premium hikes, according to a new Urban Institute report. (Getty/Designer491)

Premiums for the cheapest silver plans—the most commonly purchased on the Affordable Care Act's exchanges—increased across the country for 2018, with significant variation between different states. 

The premiums for the lowest cost silver plans increased on average by 32% between 2017 and 2018. But in Iowa, for example, plan premiums jumped by 117.5%, while in Alaska they actually decreased by 22.5%, according to the report, which was compiled by the Urban Institute with funding from the Robert Wood Johnson Foundation. 

Premiums for the cheapest gold level plans also increased by 19.1% for 2018, according to the report. 

Uncertainty and instability in the market were the main factors contributing to the increases, the report found. More payers left the markets than entered them with new plans, reflecting this trend.

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"We are worried that premium prices are continuing to increase to the point that average Americans will not be able to afford the most basic silver plan," Mona Shah, Ph.D., RWJF's program officer, said in a statement emailed to FierceHealthcare. 

"Focusing on stabilizing the markets for 2019 and beyond could help stem the tide and support consumers, especially those who are lower income," she added. 

States with the lowest premiums had a number of insurers competing in the markets or offered Medicaid managed care plans as an option, according to the report. Perhaps surprisingly, some of the states with the lowest increases for 2018 had the highest premiums in 2017. 

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Payers are gearing up to set rates for 2019 on the exchanges. Lawmakers are currently embroiled in debate over stabilization legislation that could ease some of insurers' concerns about the markets and lead to lower premiums for enrollees. However, those efforts have hit a major snag as Republicans and Democrats squabble over abortion language that was added last-minute to the plan. 

Plus, legislators much reach an agreement on the stabilization plan by the end of the week to get it in their omnibus spending bill

If Congress doesn't take steps to stabilize the markets, more premium hikes are likely, according to a report from Covered California, the state's Medicaid program. The group projects that 17 states could see "catastrophic" premium increases of up to 90% between 2019 and 2021. 

Meanwhile, some insurers are seeing their ACA offerings turn a profit after years of losses, boosted at least in part by increased premiums.