Healthcare Reform Status Report

Speaking of status reports, Jason Johnson presents a helpful status report on healthcare reform at The Root:

The Affordable Care Act had two main stated goals: The first was to increase the number of Americans who have some form of health coverage, and the second was to make health care more affordable. The first goal has been accomplished. While there are caveats, most private analyses show that about 16 million Americans have gained health care coverage through the ACA. Most of these people are poor, under 30 and minorities. However, on the cost end, the ACA has driven up costs for millions of Americans, a reality that has a disproportionate impact on minority communities, especially when it comes to pharmaceuticals.

and most of those who are newly covered are covered through the expansion of Medicaid. “Medicaid for All” does not seem to have caught on as a campaign slogan but, as I pointed out in 2009, that’s the direction in which we’re pointed.

I’ve also seen renewed calls for the “public option”, including by the president himself yesterday. The argument as I understand it is that in markets in which there is only one insurer the federal government should step in to provide “competition”. How a public insurer that depends on the taxpayer can be characterized reasonably as competition for a private company is unclear to me.

The number of insurers participating in the marketplace is shrinking and in most states those continuing to participate are losing money. California is an exception to that pattern for reasons that aren’t clear to me. As the number of insurers continues to dwindle, expect more calls for increased federal subsidies. I can’t justify private insurers dependent on federal subsidies. I think that fully government-provided insurance (perhaps I need to put double-quotes around the word “insurance”—what’s being proposed does not sound like insurance to me but like a benefit) would probably be preferable to public-private hybrids. I can’t honestly tell whether advocates really believe their neoliberal fantasies or whether it’s a mere cynical hat-tip.

4 comments… add one
  • steve Link

    “”People’s — I don’t know if you have been watching lately over the last couple of weeks — people’s premiums, George, are going up 35, 45, 55 percent,” Trump said on Oct. 25. “Their deductibles are so high nobody’s ever going to get to use it. So … Obamacare is turning out to be a bigger disaster than anybody thought.”

    On average, premiums have risen by about 5.8 percent a year since Obama took office, compared to 13.2 percent in the nine years before Obama. Is it true that we’ll see insurance plans jacked up 35 to 55 percent in 2016?

    We reached out to the Trump campaign but didn’t hear back. Experts we talked to and the data show that while there are examples of premium increases that large, they’re not the norm.

    Double digits for some plans

    Let’s begin with a brief primer on premium hikes. Under the Affordable Care Act, insurers planning to increase their rates by more than 10 percent have to submit their proposals for federal review. In many states, the companies also have to negotiate their prices with a state insurance commissioner.

    Generally, the finalized premiums will be equal to or lower than the proposed rates, according to Larry Levitt of the Kaiser Family Foundation, a leading nonpartisan health policy research center. With five days left before open enrollment begins on Nov. 1, rates are likely already approved or amended, but not all them have been publicized.

    Trump has a point that some insurers have requested increases that hit high double digits.

    “Yes, some people in some plans through some carriers in some states are, indeed, looking at rate hikes of ‘35 to 50 percent’ if they stick with those plans in 2016,” said Charles Gaba, who runs the popular blog, which tracks Obamacare enrollment.

    “This is not completely off the wall. Many of the popular plans requested high increases,” said Gail Wilensky, a health economist and the head of Medicare and Medicaid under George H.W. Bush. “Those hikes will affect more people than some may think.”

    She pointed out that Blue Cross Blue Shield, a prominent insurer with a significant amount of enrollees, proposed rate hikes of 14 to 38 percent in Illinois and 50 to 65 percent in New Mexico.

    But that’s not telling the entire story either, according to the data.

    Much lower average

    Just 7 percent of all plans in the federal exchange had a proposed rate hike of 30 percent or higher, estimates Agile Health Insurance, which bills itself as “an affordable alternative to Obamacare.” That translates to average increases at far lower levels than what Trump said.

    Looking at finalized rates for the lowest and second-lowest cost marketplace plans in the silver category — which are the basis for federal premium subsidies and chosen by 68 percent of enrollees — the average increase is nowhere near 35 to 55 percent.

    The Kaiser Family Foundation found that the cost of a benchmark silver plan will be 4.4 percent more expensive on average across major cities in 13 states and Washington, D.C. (Again, that is a smaller annual increase than what had been occurring before Obamacare became law.)”

  • Guarneri Link

    Nice straw man, steve. Dealing with the mumbling of a candidate, not the real thrust of whats going on.

    During its marketing I saw claims that 30MM, up to 40MM in some estimates, people needed to be insured. Although there appears to be hanky panky in counting who has become covered, the 15MM-ish figure does not offend the senses. That’s 50%. I call that piss poor.

    As for costs. With lower than estimated coverage has come lower than estimated cost. However, the costs are not proportionally smaller. That is, the unit costs are higher. So high cost insureds have been hived off into Medicaid and exchange vehicles, which are going under; what now, 15 or 16 of 23? The icing on the cake is that taxpayers have subsidized those costs, enabling the problem to be shielded from premium hikes. An illusion. Yet the exchanges are still dropping like flies. A day of reckoning will come soon. As for private premiums, I know my deductibles have gone up significantly. And there is no real economic difference between a higher deductible and a higher premium. Most people I have spoken to report same, and the deductibles for most are pierced, such that only the very healthy avoid an absolute equivalency between premiums and deductibles. This will encourage the young to either just not sign up, or figure a way to buy catastrophic coverage only. The proverbial death spiral.

    You add in the absolute lie about if you like your doctor………….and I don’t think Moe, Larry and Curley could have done worse in developing a scheme.

  • steve Link

    “Most people I have spoken to report same,”

    Nobody I know voted for him.

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