As of January 1, 2014, insurers are no longer able to deny coverage or charge higher premiums based on preexisting conditions (under rules referred to as guaranteed issue and modified community rating, respectively). These aspects of the Affordable Care Act (ACA) – along with tax credits for low and middle income people buying insurance on their own in new health insurance marketplaces – make it easier for people with preexisting conditions to gain insurance coverage. However, if not accompanied by other regulatory measures, these provisions could have unintended consequences for the insurance market. Namely, insurers may try to compete by avoiding sicker enrollees rather than by providing the best value to consumers. In addition, in the early years of market reform insurers faced uncertainty as to how to price coverage as new people (including those previously considered “uninsurable”) gained coverage, potentially leading to premium volatility. This brief explains three provisions of the ACA – risk adjustment, reinsurance, and risk corridors – that were intended to promote insurer competition on the basis of quality and value and promote insurance market stability, particularly in the early years of reform.
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The Affordable Care Act enrollment period doesn’t begin until November, but the recent departure of several health insurance providers from federal and state marketplaces is raising concerns of fewer choices and higher premiums.
But federal officials emphasized that consumers will still have affordable coverage options during a Wednesday conference call. Even if insurance premiums increase by 25 percent, 60 percent of Indiana consumers would be able to purchase coverage for less than $75 per month, according to a report from the U.S. Department of Health and Human Services.
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State insurance officials say they are feeling pressure to approve large ObamaCare premium increases to prevent more insurers losing money from dropping out of the market altogether.
Tennessee’s insurance commissioner, Julie Mix McPeak, this week announced the approval of premium hikes of 62 percent, 46 percent and 44 percent, respectively, for the three insurers on the state’s marketplace.
She said her department’s actuaries had found the rate increases to be justified.
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Three years ago, health economists believed Obamacare’s soon-to-launch marketplaces would grow to replace much of America’s fractured, complex employer-based health insurance system.
Predictions for the employer-sponsored insurance system’s collapse ran rampant. The question around companies shifting workers to the new public marketplaces was often framed not as if but when. University of Pennsylvania’s Zeke Emanuel pegged it at 2025. MIT’s Jonathan Gruber estimated 2050.
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Recently, Avalere worked with the Council for Affordable Health Coverage to examine enrollment trends for the Affordable Care Act (ACA).
Avalere projects that 10.1 million individuals will be enrolled in an exchange plan by the end of 2016. To date, exchange enrollment has not reached original projection numbers. In March 2010, the Congressional Budget Office predicted enrollment figures for 2016 to be at 21 million. Their projections have decreased since then- in January 2016 it was 13 million and in March 2016, it was 12 million. The Obama administration projects 10 million in enrollment for 2016.
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They say you’re damned if you do and you’re damned if you don’t. So House Speaker Paul Ryan did, and got damned on both the left and right—and all but ignored by his own party’s presidential candidate—when he unveiled his caucus’s outline for a replacement of the Affordable Care Act.
Which raises the question: How serious can this ACA alternative be? Maybe not very. The centerpiece of Ryan’s proposal—tax credits for everyone who needs to purchase individual policies regardless of income—may not go far enough to prevent people from losing coverage while creating new spending that would benefit high-income earners who can already buy their own health insurance.
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Five Republican-led states and several provider groups are suing to block a new Obamacare rule that’s meant to prevent health care providers and insurers from discriminating against transgender patients.
The five states — Texas, Wisconsin, Kentucky, Nebraska and Kansas — and the provider groups argue that the nondiscrimination rule requires doctors to perform gender transition procedures even when they are against the doctor’s medical judgment.
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Health insurance startup Oscar Insurance Corp. will reevaluate its approach to Obamacare after suffering significant losses under the U.S. program and will pull out of two markets next year.
Oscar, which pitches itself as a tech-savvy alternative to traditional health insurers, plans to end sales of Affordable Care Act plans in Dallas, a market it entered this year, and New Jersey. It’s part of a more conservative approach by the New York-based company as it plans to introduce insurance products for businesses next year.
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Democratic presidential nominee Hillary Clinton wants to crack down on rising prescription drug costs. She has made it a pillar of her campaign, the stuff of TV ads and stump speeches. She also has ambitious plans for Alzheimer’s research and other medical science initiatives.
But, even if she wins the White House, Clinton might have to put all that on hold.
A series of setbacks to Obamacare in recent months has raised real questions about the viability of the Affordable Care Act, with three major insurers announcing that they will leave many of the law’s marketplaces next year and others requesting substantial premium increases.
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“If you like your doctor, you can keep your doctor” was President Barack Obama’s signature catchphrase he used to sell the Affordable Care Act to the American people. Now Obamacare’s flagship website, healthcare.gov, no longer even addresses the issue.
Ironically, the section in question was the first public (if indirect) admission by the Obama administration that the president’s promise was less than a “guarantee.” As THE WEEKLY STANDARD first reported in July 2013, the website told consumers that they “may be able to keep your current doctor,” in contrast to the president’s unequivocal statement: “Here is a guarantee that I’ve made. If you have insurance that you like, then you will be able to keep that insurance. If you’ve got a doctor that you like, you will be able to keep your doctor.”
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