Updated Oct. 17

Oklahomans who buy health insurance on the federal exchange will see higher premiums again when open enrollment begins Nov. 1.

Recent actions by President Donald Trump to dismantle federal health-care policies also could increase costs and reduce options in years to come, particularly for people with chronic or sudden major illness, health experts and insurers say.

Trump’s recent moves include cutting Affordable Care Act enrollment outreach funds and allowing cheaper plans with fewer benefits. The administration also failed to meet a state-imposed deadline to approve Oklahoma’s request to start a reinsurance program that could have decreased premiums by 35 percent.

In the latest, and perhaps most significant, announcement, Trump ordered the government to end billions of dollars in subsidies that are sent to insurance companies to cover the cost of insuring low-income residents.

For Oklahoma, this means the loss of about $91 million that subsidized more than 78,250 enrollees, according to 2016 data analyzed by the Center on Budget and Policy Priorities.

Many Democrats and health-industry advocates have accused Trump of purposefully trying to sabotage health-insurance markets in order to force congressional holdouts to the bargaining table. This is something Trump has hinted at, including on Thursday when, after announcing an end to the subsidies, he tweeted, “Dems should call me to fix.”

Some Republican leaders praised the actions as a necessary step to weakening Obamacare, which they say has driven up costs; others are concerned it will leave too many constituents exposed to higher costs because it will drive healthy, younger people to cheaper plans, leaving mainly the sick in costlier plans. In Oklahoma, where health outcomes are poor, the stakes could be high.

Oklahoma State Medical Association President Dr. Kevin Taubman said the president’s move could have deep ramifications for Oklahoma’s insurance market, which has struggled with low enrollment and high premiums.

“This is effectively a purely political move,” he said. “At the end of the day (Trump) couldn’t get what he wants and now, to put it bluntly, he’s acting like a petulant child and he’s just throwing grenades at the market because he couldn’t find a political solution.”

Taubman said the impact largely will be felt in the coming years unless Congress acts to stabilize the market.

Some immediate effects will still be apparent.

Despite concerns that Trump’s decision could force some insurers out of the market for the upcoming plan year, which takes effect Jan. 1, Blue Cross and Blue Shield of Oklahoma confirmed Friday it plans to continue to be the only insurer offering coverage on the exchange in the state.

A company spokeswoman said that is because Blue Cross anticipated Trump would pull the subsidy funding and built the assumption into its rate-increase proposal submitted earlier this year.

That proposal calls for an average 8.3 percent rate increase across all of the individual ACA-compliant plans. This would be the third straight increase in rates and would follow last year’s 75 percent increase, which put Oklahomans’ health-care costs among the highest in the nation.

In the application, still pending before the federal government, the insurer listed the potential loss of the cost-sharing subsidy among the reasons it is raising rates.

“Blue Cross and Blue Shield of Oklahoma has accounted for the uncertainty surrounding the federal government’s funding of the members’ cost-sharing reduction in our benefit rates,” said spokeswoman Lauren Cusick. “Therefore, yesterday’s decision does not impact our market participation.”

Cusick said Blue Cross is still studying the administration’s actions to understand the full implications.

Both the governor’s office and the state Health Department said they are withholding comment until they have more time to review information about Trump’s actions.

The Blue Cross Blue Shield Association, which represents BCBS of Oklahoma, offered a more decisive outlook. In a joint statement with America’s Health Insurance Plans, the association called on the government to increase consumer choice, lower costs and stabilize markets. “Terminating this critical program will do just the opposite,” the statement said, referring to end of the cost-sharing subsidies. “This action will make it harder for patients to access the care they need. Costs will go up and choices will be restricted.”

In a statement Thursday night, White House Press Secretary Sarah Sanders called the subsidies a “bailout of insurance companies” that was illegally used to “prop up a broken system.”

She called the payments an abuse of taxpayer dollars.

A report from the non-partisan Congressional Budget Office said Trump’s move would increase the federal deficit by $194 million over the next decade because it would increase costs for the ACA’s premium tax credits.

Republicans in the U.S. House sued in 2014 to end the payments when President Barack Obama was in office, arguing the president didn’t have authority to do so without congressional approval.

Trump’s decision to end the lawsuit, which was appealed, won’t end the legal challenges. California and 17 states (Oklahoma wasn’t one of them) announced Friday they would sue to block the president’s action.

Even if the lawsuit succeeds, the damage could have already been done.

Taubman, a Tulsa surgeon, said public uncertainty or confusion about the health care law’s future could suppress enrollment for the coming plan year. That could increase rates again next year or cause Blue Cross to pull out of the marketplace, leaving the state with no insurer.

“We want a fix, and I’m the first one to agree that things need to be worked out with the current law,” he said. “But the point is we shouldn’t be playing with the lives of individuals and should instead try to find a balanced solution.”

Congressional Democrats are also accusing the Trump Administration of further sabotaging the health-care law by slashing funding for the navigator program, an outreach effort that helps consumers review their coverage options on the exchange and determine if they are eligible for financial assistance.

Many ACA supporters see this as a critical step that ensures enough people are enrolled in the marketplace, especially younger, healthier recipients whose participation in the exchange can bring down premiums for everyone.

Nationally the program, which had a $62.8 million budget last year, was cut by more than 40 percent. And the two grant recipients who serve Oklahoma – the Oklahoma Community Health Centers and the Little Dixie Community Action Agency — were cut by $171,918 and $192,445, respectively.

Becky Reynolds, executive director of the Little Dixie Community Action Agency, said the 39 percent cut to her group means it will only be able to pay about 20 navigators to assist in the statewide effort.

“We just have to do the best we can with what we have,” she said.

Cassidy Heit, a public policy and communications associate with the Oklahoma Primary Care Association who helps manage the grant for the Oklahoma Community Health Centers, said the funding reduction likely won’t affect the staffing level of the 58 full- or part-time navigators the consortium uses.

But she said that’s only because the group slashed funding on advertising and other paid marketing used to raise awareness of the health-care exchange and the navigators.

Even though the health-care law has been in place for several years, Heit said many Oklahomans remain unaware of their options or need help checking if they are eligible for subsides.

“We want to help people because the prices or the amount of financial assistance can change year to year,” she said. “And then we might have new people who are now looking to buy (on the exchange) because they had a change in circumstances.”

In a press release the Centers for Medicaid and Medicare Services said the funding adjustment, which was tied to whether navigators met their enrollment goals the previous year, are designed to make the program more efficient.

But in a letter to U.S. Health and Human Services Secretary Tom Price, before he resigned this month, top-ranking congressional Democrats accused the Trump administration of ignoring the benefits the program provides and instead trying to undermine the ACA.

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