A study by the Urban Institute says the average monthly premium for healthcare insurance in Nevada increased 45.6 percent this year.
According to the study funded by the Robert Wood Johnson Foundation, the cost of the lowest "silver" plan went from $306 to $445 a month for a 40-year-old non-smoker.
But Heather Korbulic, executive director of the Silver State Health Insurance Exchange, said most of the low-income people who get coverage from the exchange won't have to pay much if any of the increase. That's because more than 85 percent of her nearly 100,000 customers receive a federal subsidy to help pay for insurance.
The way the Affordable Care Act works, she said, the federal subsidies those customers receive will increase and pretty much cover the entire increase.
"When your rate increases your subsidy increases basically the same amount," she said.
According to a report issued this week by the Congressional Budget Office, the projected 34 percent nationwide increase in premiums will cost the federal government $10 billion more in subsidies this year.
It's the remaining 15 percent of her customers she's concerned about. Korbulic said those people in the exchange who make more than 400 percent of the federal poverty level don't get subsidies. For a single person in the 48 contiguous states, the poverty level this year is $12,140 so subsidies end for anyone making more than $48,560 a year. She said that group includes a large number of people in the trades and small businessmen.
"Those who are unsubsidized are seeing big increases in their monthly premium," she said. "We need to find opportunities for those people."
She said the cause of rising premiums has a lot to do with instability in the health insurance market — much of it caused by tactics designed to undermine the Affordable Care Act. That includes the decision to stop paying insurance companies for the Cost Sharing Reduction subsidies mandated by the ACA for consumers making between 138 and 250 percent of the poverty level.
"What used to happen in the federal government would pay those insurance companies for that," she said.
She said her biggest concern for the 15 percent who don't receive subsidies is they will be lured into Associated Health Plans or Limited Duration Plans.
"Those plans are very high deductibles, not comprehensive, don't provide maternity coverage, prescription drugs," she said, adding they can even discriminate based on pre-existing conditions — which is prohibited by the ACA.
"I'm concerned those people who are unsubsidized are going to be directed into those plans."
She said there's a big incentive for brokers to sell those plans because they get 40 percent commissions on them.
Korbulic said more volatility was created by the decision to end the individual mandate requiring everyone to buy health insurance. It was an incentive designed to make younger, healthy people get insurance, thereby ensuring insurers weren't just selling to the unhealthy. It will go away in 2019.
She said instability has also caused insurers to leave some markets. Western Nevada, for example, has access to just one plan through the exchange — Silver Summit.
"The exchange, the governor and the Insurance Division are extremely focused on bringing in competition to this market," she said. "That's the key to driving down cost but it's very difficult to being in competition in a volatile marketplace."
In the politically charged battle over the healthcare law, Korbulic said members of Congress "are not listening to healthcare policy people who are suggesting substantive ways to stabilize the marketplace."
"They're going to end up creating a scenario that creates more costs and more burdens on consumers," she said. "Uncertainty created these price increases. Continued uncertainty will probably make for more price increases next year."
But despite the endless attacks on the ACA, she said the results for Nevadans have been dramatic in terms of Medicaid expansion and increased participation in the exchange. She said the law is "hugely popular" with a public that now counts rising healthcare costs as their No. 1 concern.