ST THOMAS, USVI -- Tuesday, October 1 marks the first day across the United States where through the Affordable Care Act (ACA), individuals may sign up for coverage via a health insurance exchange. Although by January 1, 2014 all states will either have a state-based exchange, state partnership exchange or federally facilitated exchange, most territories may opt for Medicaid expansion instead.
“We appear so far to have been the only territory to officially have selected Medicaid expansion,” US Virgin Islands Governor John de Jongh said on Monday.
The other territories are expected to announce their decisions this week via notification to Health and Human Services Secretary Kathleen Sebelius.
“Similar to all jurisdictions that embrace the value of covering our residents and providing access to quality healthcare, we undertook a rigorous analysis through our Healthcare Reform Task Force and determined that in the absence of the individual mandate applying to us and the limitation on federal funding on par with the states, and inability to participate in federally facilitated or state partnership exchanges, that Medicaid expansion was best,” de Jongh added.
"Both the Office of the Governor's Health Reform Unit and the Office of the Lieutenant Governor's Banking and Insurance Division have been inundated with phone calls recently regarding if residents can sign up for a local exchange," said Taetia Phillips-Dorsett, policy advisor/health reform coordinator. “We have taken the opportunity to explain to them our circumstances, but that there is a possibility that some Virgin Islands residents may participate in an off-island exchange if they work for a subsidiary company locally and the parent company is purchasing insurance via the small business health option program.”
In July, the territory selected Medicaid expansion instead of an exchange due to the primary factors including: inadequate federal funding for exchange premium assistance/cost sharing assistance, and the difficulty in securing a state partner.
As of this date, there are 17 state run health insurance exchanges, 7 state/federal partnership exchanges and 27 that are solely federally run. The estimated insurance premium for the insurance exchanges range between $192-$516/month for many silver levels, bronze levels $8-$142 before subsidies are applied, gold and platinum plans cover 80% and 90% of total insurance costs respectively and therefore premium ranges will be higher than the bottom two tiers.
An actuarial analysis of the USVI market indicated that with the implementation of an insurance exchange, individual insurance premiums would have been $302/month for silver and slighter higher on the magnitude $100+ for gold and platinum coverage. Additionally, a projected 13,400 residents would have qualified for coverage but would have needed to be heavily subsided as under ACA.
The federal government only provided $24.9 million in total through 2019 to offer these subsidies, while the Healthcare Reform Task Force estimated that a total of $251 million would have been necessary for subsidies during the same time period, a gap of $226.1 million that would have had to be met from local financial resources.
Medicaid expansion kicked off on August 3 for pregnant women and children with an income eligibility level of $6,500 per year. The Department of Human Services anticipates additional coverage of new populations to include childless adults during a phased in approach over the next year.