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.
Despite the individual mandate and massive new government subsidies delivered directly to insurers, many participating insurers, whose continued participation is essential to the the Affordable Care Act’s future, are losing substantial money. In order to assist those insurers, the administration is now seeking a taxpayer-financed bailout for them. Congress can block taxpayer funds from being used for this purpose by extending language contained in the 2015 government funding bill.
It is now well-established that many people buying health coverage through the ACA exchanges have to pay tens of thousands of dollars – counting both premiums and deductibles – before receiving a single dollar of coverage for treatment of any illness. The well-known prohibition on charging different rates for people with higher health risks obviously makes health coverage more attractive to people with chronic conditions or a history of serious illness. It is obvious that this would increase premiums, if these were the only people to enroll in the new plans. By making premiums independent of health status, it not only made coverage more attractive to people with health problems, but also made coverage less attractive to people who are perfectly healthy.
One in five of us needs mental-health treatment at any given time, and for those who get good care, the recovery rate is between 60 percent and 80 percent — higher than in many other medical fields. But only about 40 percent of the people who need treatment get any help, and those who do “often get bounced around in a system that leaves them feeling misunderstood, stigmatized, brushed aside.”
Political discussion aside, The Affordable Care Act will fail for business reasons. The fundamental reason the ACA will fail is because it mandates a minimum Medical Loss Ratio (MLR), or the percentage of premiums paid out to cover health care expenses. The problems associated with mandating MLR are two-fold: 1) incentivizing the insurance industry to become less efficient; 2) contributing to the elimination of new insurers entering the market and increasing the level of competition.
Over the last few years, Kentucky captured the nation’s attention by wholly embracing the health care law and expanding Medicaid under the Affordable Care Act. Now, with Governor-elect Matt Bevin promising to “repeal the expansion as it currently exists,” Kentucky may become a laboratory for the kind of rollback that the law’s opponents have so far only dreamed of.
The demise of Health Republic, the largest of the nonprofit cooperatives created under ObamaCare, left its more than 215,000 enrollees scrambling to find new insurance. But New York’s physicians and hospitals say the shutdown has left them, too, in a lurch. The Medical Society of the State of New York, a physician’s association, said of 800 doctors surveyed, 43% have claims unpaid by the insurer. Of these, 18% said they were owed $25,000 or more.
The latest turmoil in health insurance marketplaces created by the Affordable Care Act has emboldened both conservatives who want to shrink the federal role and liberals who want to expand it. UnitedHealth Group announced last week that it may pull out of the marketplaces in 2017 after losing money this year. This followed the collapse of 12 of the 23 nonprofit insurance cooperatives created with federal loans under the health law. In addition, insurance markets in many states are unstable. Premiums are volatile and insurers say their new customers have been sicker than expected.
Michael Cannon of the Cato Institute, Tarren Bragdon of the Foundation for Government Accountability, and Daniel Landon of the Missouri Hospital Association joined former Secretary of the Department of Health & Human Services (HHS) Kathleen Sebelius to discuss Medicaid expansion under the Affordable Care Act.
The sudden collapse of the largest nonprofit insurance cooperative created under the Affordable Care Act is causing headaches in New York, especially for medical providers owed millions of dollars for treating the failed plan’s patients. Hospitals, doctors, and other clinicians are legally obligated to continue treating Health Republic patients through the end of the month but have been given no assurances they will ever be paid for that care.