Harvard prof Jason Furman presents his strategy for patching the Affordable Care Act in his op-ed in the Wall Street Journal:
The administration should ensure that insurance companies continue to be reimbursed for the cost-sharing subsidies they provide for households with incomes up to 250% of the federal poverty line, which is about $60,000 for a family of four. The president should also order his subordinates to continue enforcing the individual mandate and to avoid making large, abrupt changes to the marketplaces.
The “do no harm†principle extends beyond the individual market, where about 1 in 6 Americans get their health care, according to the Census Bureau. To cut cost growth and improve quality, the administration will have to use other tools—many of them bipartisan—that have been created by Congress in recent years. These include delivery-system reforms in Medicare, which shift to payment models that reimburse providers based on outcomes and quality rather than inputs and quantity. A Republican Congress under the leadership of Speaker John Boehner already expanded these reforms after they were originally passed as part of the Affordable Care Act. The “Cadillac tax,†which encourages insurance companies not to offer overly expensive care, should also stay. Neither of these policies requires congressional action. The administration simply has to implement the law as written.
I noticed that he did not mention the increase in the number of counties served by no carrier on the health care exchanges in his op-ed. I will take it on Dr. Furman’s authority that no “death spiral” is taking place. Nonetheless the number of counties served by no carriers or a single carrier is rising, as are premiums and deductibles. Clearly, something is happening.
The number of counties with no exchange offerings has increased, but this is largely in rural areas. Best estimate i have seen is that this actually affects about 2 million people. This is also largely in counties that had only one or two carriers before Obamacare.
On deductibles I have not seen anything definitive on deductibles being higher across the country. If deductibles are a concern, then you should be aware that they will increase with the GOP plans as currently written.
Premiums? We had a couple of years where there were constant scares based upon anecdotal reports, then found the increases were small. My best sense from various sources is that they are increasing now for several reasons. Some of this is just the insurers that tried to capture market share leaving because they set prices too low and were losing money. Anyone can offer low premiums. It is hard to break into a new market and get providers to agree to lower fees. Some of this is because insurers (Anthem is one) getting out because they aren’t sure what is going to happen with the GOP in charge of Obamacare. Some is also likely because Obamacare is failing, whatever that means.
Steve