‘Oba­macare’ premi­ums set to spike next year

Daily Local News (West Chester, PA) - - BUSINESS - By Ri­cardo Alonso-Zal­divar

WASH­ING­TON » 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 will 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 only have plans 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 will pounce on the num­bers as con­fir­ma­tion that in­sur­ance mar­kets cre­ated by the 2010 health over­haul are on the verge of col­laps­ing in 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. Win­dow shop­ping for plans and premi­ums is al­ready avail­able through Health­Care.gov.

The sober­ing num­bers con­firmed state-by-state re­ports that have been com­ing in for months.

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 low-in­come 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 most work­ers and their fam­i­lies rely on.

In some states, the pre­mium in­creases are strik­ing. In Ari­zona, un­sub­si­dized premi­ums for a 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. Ok­la­homa has the next big­gest in­crease for a sim­i­larly sit­u­ated cus­tomer, 69 per­cent.

Dwin­dling choice is an­other prob­lem fac­tor.

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.

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