Cost overruns are endemic to government health programs, and ObamaCare is turning out to be no different. Not only are its Medicaid expansion costs exploding, skyrocketing premiums are now pushing insurance subsidy costs through the roof.

A new study from the Center for Health and Economy finds that because of the double-digit premium increases across the country, federal spending on ObamaCare’s insurance subsidies will shoot up by nearly $10 billion next year

That’s because the amount of the subsidy is directly tied to the cost of insurance in any given market. The Obama administration treats this as a cardinal virtue of ObamaCare, because the subsidies largely shield eligible enrollees from premium rate shocks. In fact, the administration has argued that higher premiums are a good thing, because they make more people eligible for those subsidies.

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About 6.4 million people have signed up for health insurance next year under the Affordable Care Act, the Obama administration said Wednesday, as people rushed to purchase plans regardless of Republican promises that the law will be repealed within months.

The new sign-ups — an increase of 400,000 over a similar point last year — mean the health care coverage of millions of consumers could be imperiled by one of the first legislative actions of Donald J. Trump’s presidency. Hundreds of thousands of other people who took no action will be automatically re-enrolled by the federal government in the same or similar plans, officials said, and their coverage could be threatened as well. Consumers still have until the end of January to enroll.

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Federal regulators Thursday night extended the midnight deadline for Affordable Care Act insurance by four days, as consumers fought to get through to call center operators and log onto Healthcare.gov to buy insurance that takes effect Jan. 1.

“Nearly a million consumers have left their contact information to hold their place in line,” Healthcare.gov CEO Kevin Counihan said in a statement late Thursday. “Our goal is to provide affordable coverage to everyone seeking it before the deadline, and these two additional business days will give consumers an opportunity to come back and complete their enrollment for January 1 coverage.”

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Next year, taxpayers will fork over nearly $10 billion more to cover double-digit premium hikes for subsidized health insurance under the ACA, according to a study from the Center for Health and Economy. The study estimates that the cost of premium subsidies under the ACA will rise from $32.8 billion currently to $42.6 billion. Under current law, “you get a premium increase, you pour more money in,” said economist Douglas Holtz-Eakin, founder of the Center for Health and Economy. “The concern is that will feed more premium increases.” If the health care law is repealed next year, it is still yet to be seen what the remaining carriers participating in the ACA exchanges will do in 2018. It is also unclear how supportive Congress will be for subsidies going into a system slated to disappear.

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Substantially more health plans on the federal insurance marketplaces require consumers next year to pay a hefty portion of the cost of the most expensive drugs, changes that analysts say are intended to deter persistently ill patients from choosing their policies. The class of medicines known as specialty drugs treat chronic illnesses such as multiple sclerosis, rheumatoid arthritis, HIV, hemophilia, some cancers, and hepatitis C. Some medicines can cost $10,000 a month. Even a small cost-sharing requirement means patients could have to come up with thousands of dollars to get the medicines.

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Oscar Insurance Corp., the Silicon Valley-backed health-care startup, continued to lose tens of millions of dollars in the third quarter as the company exits some markets and works to diversify away from of its Obamacare business.

The New York-based company sells health insurance to individuals in new markets set up by the Affordable Care Act. Its attempt to reinvent the insurance business has been marked by large losses — in the third quarter, closely held Oscar lost $45 million in New York, Texas and California, according to filings with regulators. That follows losses of $83 million in those states during the first six months of this year.

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Obamacare architect Jonathan Gruber told CNN’s Carol Costello on Monday that it is not possible to just “get rid of the parts” of the health care law that people do not like because that was tried and “premiums went through the roof.”

Costello interviewed Gruber on her show and asked how Americans’ health care premiums would be affected if President-elect Donald Trump repealed parts of the Affordable Care Act that are unpopular after taking office.

“So, let’s say he keeps the parts of the law that people really like,” Costello said. “What would that do to all of our premiums? If he could keep all of the elements that you say that Congress might reject.”

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The White House is urging people to sign up for coverage through ObamaCare, hours after the Republican electoral sweep that likely dooms the healthcare law’s future.

Spokesman Josh Earnest said Wednesday the Obama administration remains committed to its enrollment drive, which opened Nov. 1.

“There is no specific thing in mind that we’re going to do differently now,” Earnest said as he addressed reporters for the first time since President-elect Donald Trump declared victory.

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While Obamacare has brought health insurance to millions of people in the U.S., some in the program are finding that the medical care they need is too expensive to actually use.

Michelle Harris, a 61-year-old retired waitress in northwest Montana, has arthritis in both shoulders. She gets a tax subsidy to help buy coverage under Obamacare, though she still pays $338 a month for the BlueCross BlueShield plan. Yet with its $4,500 deductible, she says she’s doing everything she can to avoid seeing a doctor. Instead, she uses ibuprofen and cold-packs.

“It hurts, but we don’t have that kind of money,” Harris said in an interview. “So I deal with it.”

Open enrollment for the insurance exchanges created by the Affordable Care Act kicks off Tuesday, and there’s a good chance consumers logging on to compare plans will face some sticker shock.

Monthly insurance premiums for popular plans on HealthCare.gov are rising by 25 percent on average next year, according to government data. But the increases will be more dramatic in certain parts of the country, especially for consumers not receiving subsidies, the numbers show.

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