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At a recent campaign rally in Las Vegas, Donald Trump tried to connect the recent news of health care premium cost hikes next year to his target audience — Nevada voters.
"It’s just been announced that the citizens of Nevada are going to experience a massive, massive -- in fact, I don’t even want to tell you what the number is, I won’t because you’ll walk out of here depressed -- double-digit hike in their Obamacare premiums for the year," he said. "Ten of Nevada’s 16 counties will have only Obamacare, and think of it, you can have one, exchange insurer that you can choose from. They are in a very good position to negotiate with you, aren’t they?"
Trump, who wants to repeal and replace the Affordable Care Act, threw out some pretty specific figures in terms of Nevada health care costs, making us curious as to how accurate he was. While he largely gets the numbers correct, Trump’s rhetoric overstates the impact of rate hikes that Nevadans enrolled in the state’s insurance market will face next year.
A big league premium hike?
Republicans across the country have seized on recent news that health care premium costs under President Barack Obama’s healthcare law would increase by an average of 25 percent across the 39 states using the federal online marketplace, coupled with about 28 percent of insurers leaving the marketplace.
The premium hikes for some plans in some states are striking: a Kaiser Family Foundation study cites a hypothetical 27-year-old in Arizona who could see the monthly cost of a "second-lowest cost silver plan" jump from $196 to $422, or 116 percent.
The average cost for a plan through Nevada Health Link, a state-managed website that uses the federal HealthCare.gov marketplace, is also going up.
The state is on track for an average increase of about 12 percent for unsubsidized premium costs, which is the eleventh-lowest hike in the country.
While a double-digit rise in premium costs is nothing to scoff at, Nevada Health Link spokeswoman Janel Davis said about 87 percent of Nevadans enrolled in an exchange plan receive a tax credit to help pay down insurance costs and that the subsidy should increase in lockstep with any rise in premium.
Davis said it’s difficult to calculate an average dollar increase in premium costs because the subsidy is dependent on a variety of factors including income, family size and age.
Trump is also correct that most Nevada counties will only have one insurer, but he didn’t get the number of counties in the state quite correct.
Nevada has 16 standard counties and the independent Carson City, which is counted as the equivalent of a county by the exchange and census. An emailed version of Trump’s prepared remarks cites 17 counties in the state, though the version on the campaign’s website has 16.
Regardless, a large percentage of Nevada counties (59 percent) only have one insurer to choose from. However, the majority of Nevadans enrolled through the exchange live in counties with more than one insurer.
According to Kaiser more than 90 percent (79,000) of Nevadans enrolled in the exchange have at least three insurers to choose from, while only 3 percent (3,000) are enrolled in mostly rural counties with only one insurer.
And unlike other states, none of the three insurers in Nevada are planning to leave the exchange marketplace in 2017.
Nevada Republican Reps. Joe Heck, Cresent Hardy and Mark Amodei have introduced a bill exempting counties with only one insurer from the individual mandate penalty, though the legislation hasn’t moved forward since being introduced in September.
Trump said Nevadans will see a "double-digit hike in their Obamacare premiums for the year" and "10 of Nevada’s 16 counties will only have one Obamacare...exchange insurer"
Trump is mostly correct, but his rhetoric is a little overstated. Nevadans who get health insurance through the exchange will see their unsubsidized premium costs rise by about 12 percent (although most people in the exchange receive subsidies). Most counties in the state will only have one insurer on the exchange next year, but about 97 percent of enrollees live in a county with at least two insurers.
Still, the basic facts are correct. We rate Trump’s statement as Mostly True.
Phone interview with Janel Davis, Nevada Health Link communications director, Nov. 2, 2016
Email interview with Charles Munoz, Trump Nevada state director, Nov. 1, 2016
Donald Trump campaign website, "IN NEVADA, TRUMP PROMISES REAL CHANGE THAT WILL BRING BACK JOBS & SECURITY," Oct. 30, 2016
Las Vegas Review-Journal, "Nevadans will pay more for Obamacare plans, but it could have been much worse," Oct. 27, 2016
ACASignups.net, "UPDATE x2: 2017 Rate Hikes: Yes, Medicaid Expansion matters. So do State-Based Exchanges and Transitional Policies," Oct. 27, 2016
Associated Press, "Obama administration confirms double-digit premium hikes," Oct. 24, 2016
ACASignups.net, "Nevada: Approved 2017 *unsubsidized* indy mkt rate hikes: 10.6% (vs. 15% requested)," Oct. 7, 2016
Kaiser Family Foundation, "Preliminary Data on Insurer Exits and Entrants in 2017 Affordable Care Act Marketplaces," Aug. 28, 2016
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