Obama’s health plan hit by dou­ble-digit pre­mium hikes

Kuwait Times - - HEALTH & SCIENCE -

Pre­mi­ums will go up sharply next year un­der Pres­i­dent Barack Obama’s health care law, and many con­sumers will be down to just one in­surer, the ad­min­is­tra­tion con­firmed Mon­day. That’s sure to stoke another “Oba­macare” con­tro­versy days be­fore a pres­i­den­tial elec­tion.

Be­fore tax­payer-pro­vided sub­si­dies, pre­mi­ums for a mi­dlevel bench­mark plan will in­crease an aver­age of 25 per­cent across the 39 states served by the fed­er­ally run on­line mar­ket, ac­cord­ing to a re­port from the Depart­ment of Health and Hu­man Ser­vices. Some states will see much big­ger jumps, oth­ers less.

More­over, about 1 in 5 con­sumers will have plans only from a sin­gle in­surer to pick from, af­ter ma­jor na­tional car­ri­ers such as Unit­edHealth Group, Hu­mana and Aetna scaled back their roles. “Con­sumers will be faced this year with not only big pre­mium in­creases but also with a de­clin­ing num­ber of in­sur­ers par­tic­i­pat­ing, and that will lead to a tu­mul­tuous open en­roll­ment pe­riod,” said Larry Le­vitt, who tracks the health care law for the non­par­ti­san Kaiser Fam­ily Foun­da­tion.

Repub­li­cans pounced on the num­bers as a warn­ing that in­sur­ance mar­kets cre­ated by the 2010 health over­haul are tee­ter­ing to­ward a “death spi­ral.” Sign-up sea­son starts Nov 1, about a week be­fore na­tional elec­tions in which the GOP re­mains com­mit­ted to a full re­peal. “It’s over for Oba­macare,” Repub­li­can pres­i­den­tial can­di­date Don­ald Trump said at a cam­paign rally Mon­day evening in Tampa, Florida.

Trump said his Demo­cratic ri­val, Hil­lary Clin­ton, “wants to dou­ble down and make it more ex­pen­sive and it’s not gonna work . ... Our coun­try can’t af­ford it, you can’t af­ford it.” He promised his own plan would de­liver “great health care at a frac­tion of the cost.” The new num­bers aren’t too sur­pris­ing, said Sen. Or­rin Hatch, R-Utah, who chairs a com­mit­tee that over­sees the law. It “does lit­tle to dis­pel the no­tion we are see­ing the law im­plode at the ex­pense of mid­dle-class fam­i­lies.”

HHS es­sen­tially con­firmed state-by-state re­ports that have been com­ing in for months. Win­dow shop­ping for plans and pre­mi­ums is al­ready avail­able through Health­Care.gov. Ad­min­is­tra­tion of­fi­cials are stress­ing that sub­si­dies pro­vided un­der the law, which are de­signed to rise along­side pre­mi­ums, will in­su­late most cus­tomers from sticker shock. They add that con­sumers who are will­ing to switch to cheaper plans will still be able to find bar­gains.

“Head­line rates are gen­er­ally ris­ing faster than in pre­vi­ous years,” ac­knowl­edged HHS spokesman Kevin Griffis. But he added that for most con­sumers, “head­line rates are not what they pay.” The vast ma­jor­ity of the more than 10 mil­lion cus­tomers who pur­chase through Health­Care.gov and its state-run coun­ter­parts do re­ceive gen­er­ous fi­nan­cial as­sis­tance. “En­roll­ment is con­cen­trated among very low­in­come in­di­vid­u­als who re­ceive sig­nif­i­cant government sub­si­dies to re­duce pre­mi­ums and cost-shar­ing,” said Caro­line Pear­son of the con­sult­ing firm Avalere Health. But an es­ti­mated 5 mil­lion to 7 mil­lion peo­ple are ei­ther not el­i­gi­ble for the in­come-based as­sis­tance, or they buy in­di­vid­ual poli­cies out­side of the health law’s mar­kets, where the sub­si­dies are not avail­able. The ad­min­is­tra­tion is urg­ing the lat­ter group to check out Health­Care.gov. The spike in pre­mi­ums gen­er­ally does not af­fect the em­ployer-pro­vided plans that cover most work­ers and their fam­i­lies. In some states, the pre­mium in­creases are strik­ing. In Ari­zona, un­sub­si­dized pre­mi­ums for a hy­po­thet­i­cal 27-year-old buy­ing a bench­mark “sec­ond-low­est cost sil­ver plan” will jump by 116 per­cent, from $196 to $422, ac­cord­ing to the ad­min­is­tra­tion re­port. But HHS said if that hy­po­thet­i­cal con­sumer has a fairly mod­est in­come, making $25,000 a year, the sub­si­dies would cover $280 of the new pre­mium, and the con­sumer would pay $142. Caveat: if the con­sumer is making $30,000 or $40,000, his or her sub­sidy would be sig­nif­i­cantly lower. Dwin­dling choice is another is­sue.

The to­tal num­ber of Health­Care.gov in­sur­ers will drop from 232 this year to 167 in 2017, a loss of 28 per­cent. (In­sur­ers are counted mul­ti­ple times if they of­fer cov­er­age in more than one state. So Aetna, for ex­am­ple, would count once in each state that it par­tic­i­pated in.) Switch­ing in­sur­ers may not be sim­ple for pa­tients with chronic con­di­tions. While many car­ri­ers are of­fer­ing a choice of plan designs, most use a sin­gle pre­scrip­tion for­mu­lary and physi­cian net­work across all their prod­ucts, ex­plained Pear­son. “So, en­rollees may need to change doc­tors or drugs when they switch in­sur­ers,” she said.

Over­all, it’s shap­ing up to be the most dif­fi­cult sign-up sea­son since Health­Care.gov launched in 2013 and the com­puter sys­tem froze up. En­roll­ment has been lower than ini­tially pro­jected, and in­sur­ers say pa­tients turned out to be sicker than ex­pected. More­over, a com­plex in­ter­nal sys­tem to help sta­bi­lize pre­mi­ums has not worked as hoped for. None­the­less, Obama says the un­der­ly­ing struc­ture of the law is sound, and cur­rent prob­lems are only “growing pains.” The pres­i­dent has called for a government-spon­sored “public op­tion” in­sur­ance plan to com­pete with pri­vate com­pa­nies.

Repub­li­cans, in­clud­ing Trump, are united in call­ing for com­plete re­peal, but they have not spelled out how they would ad­dress the prob­lems of the unin­sured. Clin­ton has pro­posed an ar­ray of fixes, in­clud­ing sweet­en­ing the law’s sub­si­dies and al­low­ing more peo­ple to qual­ify for fi­nan­cial as­sis­tance. — AP

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