ObamaCare’s impact on health costs.

Although a median-income US family of four with employer-based health insurance saw its gross annual income increase from $76,000 in 1999 to $99,000 in 2009 (in current dollars), this gain was largely offset by increased spending to pay for health care. Monthly spending increases occurred in the family’s health insurance premiums (from $490 to $1,115), out-of-pocket health spending (from $135 to $235), and taxes devoted to health care (from $345 to $440). After accounting for price increases in other goods and services, the family had $95 more in monthly income to devote to nonhealth spending in 2009 than in 1999. By contrast, had the rate of health care cost growth not exceeded general inflation, the family would have had $545 more per month instead of $95—a difference of nearly $5,400 per year. Even the $95 gain was artificial, because tax collections in 2009 were insufficient to cover actual increases in federal health spending. As a result, we argue, the burdens imposed on all payers by steadily rising health care spending can no longer be ignored.

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The Maryland Health Care Commission has launched a new online pricing tool that allows state residents to compare the costs of several common procedures.

The “Wear the Cost” initiative provides prices from hospitals in the state for hip replacements, knee replacements, hysterectomies and vaginal births. The calculations are based on commercial insurer data from 2014 and 2015. Development support on the project was provided by the Altarum Institute.

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In this issue of JAMA, Emanuel and colleagues propose an Affordability Index to measure the ability of the average US household to pay for its medical expenses. As the authors point out, standard economic measures used to track health spending do not adequately represent the effect of rising costs on families.

Emanuel and colleagues correctly observe that aggregated measures of health spending in the United States are not helpful to most people. Their intent is to create a measure using readily accessible data that is intuitive and easy for the average person to understand. Such an index, if widely adopted, might help galvanize public support for efforts to bring more cost discipline to the provision of medical care.

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The premiums for 2018 Marketplace plans were recently released to give consumers a chance to look at their plan options before open enrollment begins on November 1. Premiums are rising significantly in many counties across the country, in part due to the decision of the Trump Administration to cease payments to insurers for cost-sharing reductions. Insurer participation also declined in many areas, leaving more counties with only one insurer, which likely contributed to the high rate of premium growth.

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For some lower-income people in Obamacare, the rising premiums President Donald Trump has talked so much about will barely be felt at all. Others, particularly those with higher incomes, will feel the sharp increases when insurance sign-ups begin Wednesday.

Richard Taylor is one of the people on the wrong end. The 61-year-old, self-employed Oklahoman has meticulously tracked his medical costs since 1994. In 2013, he signed up for an Affordable Care Act plan for the law’s first year offering coverage to millions of Americans.
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President Trump’s decisions on cost-sharing subsidies have contributed to the law’s rising premiums and the resulting rise in subsidies. But he’s not responsible for all of this. Competition, for example, took a big hit last year — when President Obama was still in charge.

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The average price of the most popular types of Obamacare health plans sold on the federal insurance marketplace will be at least 34 percent higher in 2018, according to an analysis released Wednesday.

The Avalere Health analysis also found lower — but still double-digit — average price hikes for the other types of Obamacare plans, which go on sale Nov. 1.
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The West Virginia Insurance Commission approved rate increases for Highmark West Virginia and CareSource Insurance’s services sold in the “Obamacare” exchange.

MetroNews learned Tuesday premiums for Highmark West Virginia will increase by 25.6 percent, while CareSource Insurance will have a 19.6-percent increase in its rate.

Eight-five percent of the around 25,000 residents who received health care through the exchange last year received a government subsidy, but those who did not saw a 32-percent increase in monthly premiums.

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Paul Melquist of St. Paul, Minn., has a message for the people who wrote the Affordable Care Act: “Quit wrecking my health care.”

Teri Goodrich of Raleigh, N.C., agrees. “We’re getting slammed. We didn’t budget for this,” she says.

Millions of people have gained health insurance because of the federal health law. Millions more have seen their existing coverage improved.

But one slice of the population, which includes Melquist and Goodrich, is unquestionably worse off. They are healthy people who buy their own coverage but earn too much to qualify for help paying their premiums. And the premium hikes that are being announced as enrollment looms for next year — in some states, increases topping 50 percent — will make their situations more miserable.

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Obamacare plan premiums may increase an average of 45 percent in Florida next year due to health care insurers rate hike requests, according to Florida’s Office of Insurance Regulation.

There are six insurers in Florida selling plans on and off the exchanges in 2018 including Blue Cross and Blue Shield, Celtic Insurance Company, Florida Health Care Plan, Health First Commercial Plans, Health Options, and Molina Healthcare of Florida.

Molina Healthcare requested the highest rate increase of 71.2 percent. Individuals with this coverage can expect their monthly premium to increase from $402 to $688.

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