Spike in premiums portends death of Obamacare

increases. There, price hikes average 30 percent, with one plan penciling in an astonishing 91.4 percent jump.

It is not hard to see why prices might spike. Thanks to Republican efforts to sabotage Obamacare, the pool of individual-market enrollees is getting smaller and sicker — and, as a result, much more expensive.

A formal Obamacare repeal famously bombed last year, of course. Americans stormed town halls and jammed lawmakers’ phone lines in the name of saving the Affordable Care Act. The once-toxic law received a bump in popularity, and surpassed 50 percent favorability for the first time since passage in 2010.

After many unsuccessful attempts at legislative “repeal and replace,” Republicans gave up and moved on. Or so it seemed.

Behind the scenes, they quietly continued their demolition project.

Perhaps most significant, the GOP tax law passed in December repealed the individual mandate. This freed healthy people to drop their insurance plans without penalty.

The Congressional Budget Office has projected that eliminating the mandate alone will increase individual-market premiums by about 10 percent in most years over the next decade, relative to prices with the mandate in place.

Meanwhile, the Trump administration has been working to make it easier for people to buy insurance that doesn’t comply with Obamacare’s consumer protections, such as required coverage of prescription drugs and mental-health care, or no bar to people with pre-existing conditions.

Additionally, Trump officials made it harder in general for people to enroll in Obamacare-compliant plans, for example, by shortening the open enrollment period this past fall, and reducing outreach and advertising.

The net effect of all these changes: Younger, healthier and cheaper enrollees are getting siphoned out of the Obamacare marketplace. Older, sicker and moreexpensive people are sticking around, because they actually need coverage.

This pool of remaining enrollees raises average costs for insurers, who then raise premiums, which drives out additional relatively healthy people, which pushes premiums up further.

Or, as Maryland’s insurance commissioner, Alfred W. Redmer Jr., put it in a call with reporters: “I believe we’ve been in a death spiral for a year or two.”

Maryland has already seen its marketplace numbers plummet. In March 2017, 243,000 people enrolled in individual plans, Redmer said; a year later, enrollment has fallen to about 211,000.

The share of Americans overall who have health insurance of any kind also has been falling since President Trump took office — and is expected to fall further, thanks not only to individual-market sabotage but also some states’ new restrictions on Medicaid eligibility.

What’s especially depressing about these trends is that, before Republicans started monkeying with things, it looked as though the individual marketplaces were stabilizing.

“With insurers now mostly profitable in the ACA individual insurance market, I would have expected single-digit premium increases for 2019 reflecting healthcost growth,” says Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation. “With repeal of the individual mandate and expansion of short-term plans, doubledigit hikes are now likely.”

What all this means for the coming midterm elections remains an open question. Most exchange enrollees will be shielded from premium increases thanks to incomebased subsidies, and despite Democratic fever dreams, voters don’t seem all that motivated by health care.

Still, it couldn’t hurt Republicans to actually try to get this stuff right.