Neither side thought it would happen after a year of turbulenceand uncertainty under the Trump administration’s efforts to kill the Affordable Care Act. But insurers are actually anticipating a relativelypopular year, even if they stuck to the ACA’s exchanges instead ofbailing out.

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A report in The Hill says that analysts and experts point tohigher-than-expected enrollment, among otherfactors, as drivers of what could turn out to be a decent year forinsurance companies.

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Katherine Hempstead, who directs the Robert Wood JohnsonFoundation’s work on health insurance coverage, says, “I think thefact that enrollment is better than expected is good for insurersthat really concentrate on the subsidized population.”

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She adds, “I would think those insurers are feeling good. … It’sgood for all the carriers that stayed in the market, but especiallygood for carriers that focus on subsidized people in themarket.”

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While Republicans had harped on their tired tune that the ACA isa failure, Democrats feared that the Republicans’ sabotage ofeverything from advertising of open enrollment to subsidies toinsurers for low-income customers would sink the law. But just ahalf million fewer people signed up this year than last, withnumbers during the shortened signup period hitting 8.7 million aslocal and state groups pushed harder to remind people to enroll inspite of their curtailed time and money limitations.

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In addition, insurers raised premiums in anticipation of lossesfrom cut subsidies, which meant that the federal government wasactually on the hook for higher subsidy payments for customersbecause it canceled payments to insurers. And that means theindustry could see a continuation of the profitable, stable trendthat began in early 2016.

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As a result, not only do analysts at Goldman Sachs, S&PGlobal Ratings and A.M. Best predict a profitable and stable 2018for insurers, A.M. Best revised its insurance industry outlook tostable from negative, based on insurers’ adaptability and improvedearnings.

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Centene, CareSource and Blue Cross Blue Shield all filled thegap in counties that would otherwise have no ACA option; they’realso the firms expected to see the most benefit.

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Hempstead says in the report, “The ones that are in the marketafter a lot of exits are more comfortable, more stable andunderstand, and [they] are not as easily shaken. You’re gettingdown to a more experienced, committed group of insurers. … Ifthere’s an individual market, they’re going to serve it. They’regoing to figure out how to make it work.”

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A Q3 analysis by the Kaiser Family Foundation found insurerswere already regaining profitability and the markets werecontinuing to stabilize before Trump canceled the subsidies, butdespite the cancellation, it’s likely that insurers will come outof 2017 on the plus side of the balance sheet.

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“It’s likely [canceling subsidies] would diminish their profits,but that insurers will still end up with a more favorable year in2017 than they had in any of the previous years of the ACAmarketplaces,” Cynthia Cox, director for the Program for the Studyof Health Reform and Private Insurance at Kaiser, is quoted in thereport.

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Cox adds, “We’re still expecting 2017 to end up being aprofitable year for many insurers in the individual market despitethe loss of cost-sharing payments,” she said. And experts don’texpect much of an effect on enrollment or the marketplace.

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Of course, there are still bumps in the road ahead, such as theelimination of the individual mandate and the possible exit of moreinsurers from the marketplaces—as well the potential lack of actionin a dysfunctional Congress on the potential return of cost-sharingreductions. There’s also the possibility that two administrativerules could siphon off healthy people, which could further drive uppremiums.

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According to Chris Sloan, a senior manager at health careconsulting firm Avalere, the drama of 2017 is not likely to berepeated in 2018.

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Sloan says in the report, “I don’t think [2018] will be aschaotic as last year, with the constant repeal-and-replacelegislation and major policy changes, like the elimination of theindividual mandate and end of cost-sharing reductions.”

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However, he warns, “But continued reductions in the market andsubstantial premium increases year after year is not sustainable.The market has weathered it, but given the trajectory that we’reon, it’s not a healthy trajectory for the exchange.”

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