USA TODAY International Edition
TOO SOON TO WRITE OBITUARY FOR ACA
Obamacare does have problems but works well in many states
Republicans repeatedly claim that Obamacare is in a “death spiral.” This is wishful thinking on their part, with little evidence to support it.
“The law is collapsing,” House Speaker Paul Ryan told Fox News
Sunday last weekend. He cited limited choices in some states and insurance companies pulling out of some markets, and he predicted “massive” premium increases in the future.
On Saturday, a day after the Republicans failed to get their replacement measure through the GOP- controlled House, President Trump tweeted: “ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!”
In reality, the marketplaces for those buying their own coverage under the Affordable Care Act are ailing — but very much alive.
Federal officials announced a few days ago that 12.2 million people were signed up to be covered by health insurance policies sold through the federal and state ACA marketplaces, or exchanges, this year — down less than 4% from a year ago.
Furthermore, this year’s signup figure doesn’t include “waiting in line” sign- ups that California and three other states allowed for people who had started the enrollment process before the Jan. 31 cut- off. Also, Louisiana recently expanded Medicaid, so some who had obtained coverage in 2016 through the Obamacare exchanges are now covered.
Indeed, independent experts predict that the Obamacare exchanges, unless repealed by the GOP Congress, are likely to remain stable for many years.
“If nothing else changed, they would probably stabilize at a lower level of enrollment,” said Mark V. Pauly, a professor of health care management at the University of Pennsylvania’s Wharton School.
That’s also the judgment of the nonpartisan Congressional Bud- get Office, which said either the ACA exchanges or the proposed GOP replacement “would probably be stable in most areas.”
NO ‘ IMPLOSION’ The ACA does have serious problems. The insurance industry’s lobbying group, America’s Health Insurance Plans, said these include “significant increases in average premiums in 2017, fewer health plan choices, and lowerthan- expected exchange enrollment and risk pool stability challenges in some states.”
On average, those signing up for ACA policies have been older, sicker and more expensive to care for than many insurance companies had expected. Companies have raised premiums, and some have stopped writing ACA marketplace policies altogether.
Problems have been particularly acute in Tennessee, where Humana has announced it will cease offering ACA policies in 2018. That would leave people in 16 of the state’s 95 counties without any ACA option next year, unless some other insurer steps in.
But Tennessee is not typical. In a letter to Congress, the National Association of Insurance Commissioners said in January that markets are near collapse in “a few” states, but “in some other states the individual market is robust with increased enrollment and premiums have stabilized.” That letter was signed by Tennessee Insurance Commissioner Julie Mix McPeak, the national association’s president- elect, and by the top insurance regulators for Texas, Maine and Wisconsin.
In Arizona, virtually all enroll- ees have only one carrier option, said Louise Norris, who tracks insurance markets for healthinsurance. org, an independent health insurance guide for consumers. Oklahoma is one of five states with only one insurance company participating, according to the Kaiser Family Foundation’s report on insurer participation, and the average premium there for a benchmark plan increased 69% this year. And most of North Carolina is served only by Blue Cross Blue Shield, which says it has lost $ 405 million on ACA plans over a two- year period.
An example of a healthy market is New York, where 17 insurance carriers offer plans. The state just announced a 28% increase in total enrollments for this year.
And in Wisconsin, Idaho, Massachusetts, New Mexico, Arkansas and California, there is still vigorous participation by insurance companies. Wisconsin alone had 14 insurance companies offering ACA policies.
NEW INSURERS STEP IN As Aetna, Humana and others have pulled out of some states, some new companies have gotten in for 2017, among them Bright Health in Colorado, Cigna in North Carolina and Virginia, and Wellmark in Iowa.
USA TODAY reported that even Aetna, which has stopped writing ACA policies in 11 states, made nearly $ 12 million on individual ACA plans in Texas and more than $ 8 million in Pennsylvania before it pulled out of those states, according to filings with state regulators. And the newspaper also reported that Blue Cross Blue Shield of North Carolina, after its big losses in 2014 and 2015, was taking in hundreds of millions more than it was paying out to beneficiaries in 2016.
What’s often lost in the GOP’s recitations of Obamacare’s problems is that the large majority of those covered by private ACA policies don’t feel the effect of rising premiums because they get subsidies.
Mark Twain wrote in 1897 that “the report of my death was an exaggeration.” The same can be said of GOP claims that Obamacare is fatally ill. If Republicans want it dead, they’ll probably have to kill it themselves.