ObamaCare’s impact on health costs.
ObamaCare plans have substantially raised the amount of cost sharing they require for drugs. Often they don’t cover any specialty drug costs until a patient has hit their deductible. There is also the issue of the dwindling number of specialty drugs that health plans include in their formularies, and provide any coverage for. Almost all of the “Silver” plans offered under ObamaCare sport closed drug formularies, where there’s no coverage for drugs not listed on the narrow formulary lists. This means when a drug doesn’t make a health plans list, consumers are completely uncovered.
Individuals who do not obtain health coverage, through any source, are subject to a tax penalty unless they meet certain exemptions. The penalties under the so-called individual mandate were phased in over a three-year period starting in 2014 and are scheduled to increase substantially in 2016. This analysis from the Kaiser Family Foundation provides estimates of the share of uninsured people eligible to enroll in the marketplaces who will be subject to the penalty, and how those penalties are increasing for 2016.
Those without health insurance have a lot to consider. On one hand, the fine for remaining uninsured steeply increases for next year. On the other, the cost of the individual mandate penalty is cheaper than buying the least expensive insurance plan for 7.1 million of the nearly 11 million uninsured eligible to enroll in health exchanges, according to a Kaiser Family Foundation analysis released Wednesday.
The penalty for failing to have health insurance is going up next year, perhaps even higher than expected. Among uninsured individuals who are not exempt from the ObamaCare penalty, the average household fine for not having insurance in 2015 will be $661, rising to $969 per household in 2016, according to a Kaiser Family Foundation analysis.
An increasing number of preferred provider plans (PPOs) offered under the health care law have no ceiling for out-of-network costs, leaving policyholders facing unlimited financial exposure. Forty-five percent of the silver level PPO plans coming to the market for the first time in 2016 provide no annual cap for policyholders’ out-of-network costs, an analysis by the Robert Wood Johnson Foundation finds.
Democrats like to talk a lot about being the party of choice, but under Obamacare, individuals are finding their choices increasingly limited. At its core, Obamacare forces individuals to purchase government-approved insurance policies and precludes them from buying plans that might be more in line with their healthcare needs. Though Obamacare’s defenders argue that the requirements imposed on health insurance plans only serve to guarantee that individuals have better coverage, in reality, what’s happening is that the law is driving insurers to limit choices.
While the average premium for the least expensive closed network silver plan — principally HMOs — rose from $274 to $299, a 9 percent increase, the average premium for the least expensive PPO or other silver-level open access plan grew from $291 to $339, an 17 percent jump. Consumers seeking health policies with the most freedom in choosing doctors and hospitals are finding far fewer of those plans offered on the insurance marketplaces next year. And the premiums are rising faster than for other types of coverage.
- 31% have delayed medical care because of cost, unchanged from 2014
- Figure has not fallen since ACA reforms
- Americans more likely to put off care for serious condition
The backlash over ObamaCare deductibles will only intensify as customers shopping for 2017 plans a year from now face bronze-plan deductibles as high as $7,150. The Department of Health and Human Services on Friday detailed many key ObamaCare parameters for 2017, including a $300, or 4.4%, rise in the maximum out-of-pocket expense for covered medical bills — not including premium payments — from $6,850 in 2016.
A Kaiser Health News analysis of costs in the three-dozen states selling policies through the federal healthcare.gov website found a sharp difference in premium prices between plans that offer out-of-network care and those that do not. The analysis compared the monthly premiums for the least expensive silver-level plans — the category that are the most popular purchases — for a 40-year-old in each county. While the average premium for the least expensive closed network silver plan—principally HMOs—rose from $274 to $299, a 9 percent increase, the average premium for the least expensive PPO or other silver-level open access plan grew from $291 to $339, an 17 percent jump, KHN found. The cost variations hold true for any age.