ObamaCare’s impact on health costs.

UnitedHealthcare’s decision to quit insurance exchanges in about 30 states next year has patient advocates concerned that fewer options could force consumers to pay more for coverage and have a smaller choice of network providers.

The company’s departure could be felt most acutely in several counties in Florida, Oklahoma, Kansas, North Carolina, Alabama and Tennessee that could be left with only one insurer, according to an analysis by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

To sell policies next year on the health law’s exchanges, also called marketplaces, insurers must apply within the next few weeks and get state approval this summer.

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Health insurance companies are laying the groundwork for substantial increases in ObamaCare premiums, opening up a line of attack for Republicans in a presidential election year.

Many insurers have been losing money on the ObamaCare marketplaces, in part because they set their premiums too low when the plans started in 2014. The companies are now expected to seek substantial price increases.

“There are absolutely some carriers that are going to have to come in with some pretty significant price hikes to make up for the underpricing that they did before,” said Sabrina Corlette, a professor at Georgetown University’s Center on Health Insurance Reforms, while noting that the final picture remains unclear.

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The Obama administration has published rules that “will make it impossible to offer HSA-qualified plans in the future” in the ACA exchanges, according to HSA expert Roy Ramthun. That’s because plans offered in the exchanges must comply with HSA and new ACA rules that conflict. This is one more way in which the ACA is limiting options to people getting coverage through the Obamacare exchanges, giving enrollees fewer of the options available to those with private and employer coverage outside the exchanges.  Nationwide, nearly 20 million people were enrolled in HSA-qualified plans last year.

Many health-insurance premiums rose again this year, sometimes by double digits. A lot of the increases were accompanied by higher deductibles as well. Insurers say the increases are justified because their costs have risen as more people with health problems have signed up for insurance in the wake of the Affordable Care Act.

Some policy experts see the higher out-of-pocket costs as a positive development. When patients have a bigger stake in the cost of their care, the argument goes, they can drive prices down by spurning providers and services that are overpriced and inefficient.

Others argue, however, that it’s unfair to put the responsibility for reducing health costs on patients—particularly those with lower incomes, for whom quality health care is increasingly out of reach.

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Amid rising drug and health care costs and roiling market dynamics, the spokesperson for the nation’s health insurers is predicting substantial increases next year in ObamaCare premiums and related costs.

Without venturing a specific percentage increase, Marilyn Tavenner, the president and CEO of America’s Health Insurance Plans, said in an interview with Morning Consult that the culmination of market shifts and rising health care costs will force stark increases in health insurance rates in the coming year.

The warning to consumers from Tavenner, the former administration official who headed the Center for Medicare and Medicaid Services and oversaw the disastrous launch of HealthCare.gov, the ObamaCare website, comes at a time of growing uncertainty about the evolving makeup of the ObamaCare health insurance market.

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In January, CMS proposed overhauling the way it evaluates if and how much money ACOs are saving in the Medicare Shared Savings Program (MSSP). Under the revised methodology, the agency would adjust cost benchmarks based on regional rather than national spending data when an ACO signs up for a second three-year contract period.

Of 434 ACOs participating in the program, only 22 have chosen to participate in tracks that include downside risk.

Despite the extraordinarily large growth in Medicaid spending and the evidence that much of that spending is of low value to enrollees, the president is requesting more than $100 billion in additional Medicaid spending over the next decade.

 

Employers that offer a health savings account might gain a competitive advantage in employee recruitment and retention. An HSA can significantly reduce employees’ taxes while giving them an important investment option, making an HSA a valuable financial wellness tool, writes Liz Ryan. HSAs can be offered as a long-term benefit like a 401(k) as well as an emergency fund for unexpected expenses, Ryan writes.

The analysis, based on claims from 21 Blue Cross and Blue Shield insurers around the country, highlights a challenge the companies say they face covering the population that signed up for plans issued under the ACA, sold both on the law’s signature marketplaces and outside them.

A number of Blue Cross and Blue Shield insurers faced increasing financial losses in 2015 on their ACA business, and some have responded by raising rates or tweaking their approaches this year.

Health insurance premiums have increased faster than wages and inflation in recent years, rising an average of 28 percent from 2009 to 2014 despite the enactment of Obamacare, according to a report from Freedom Partners.

The Obama administration expressed concern in 2009 about skyrocketing health care premiums in a report entitled, “The Burden of Health Insurance Premium Increases on American Families.” They were concerned that premiums had increased by 5.5 percent from 2008 to 2009.

However, from 2010 to 2011 in the first year after Obamacare was enacted, premiums increased by 9.4 percent.

According to the report, while premiums increased by 28 percent from 2009 to 2014, wages increased by only 7.8 percent. From 2004 to 2009 when premiums increased by 30 percent, wages increased by only 12.2 percent.