August 19, 2016
According to an analysis done for The Upshot by the McKinsey Center for U.S. Health System Reform, 17 percent of Americans eligible for an Affordable Care Act plan may have only one insurer to choose next year. The analysis shows that there are five entire states currently set to have one insurer, although our map also includes two more states because the plans for more carriers are not final. By comparison, only 2 percent of eligible customers last year had only one choice.
A similar analysis by Avalere Health, another consulting firm, also highlighted the increase in areas with only one insurance carrier.
Source: Obamacare Options? In Many Parts of Country, Only One Insurer Will Remain – The New York Times
August 19, 2016
UnitedHealth expects to lose $850 million on Obamacare in 2016, while Aetna, Anthem, and Humana are all on track to lose at least $300 million each on their ACA plans this year, according to company reports and estimates from Bloomberg Intelligence. UnitedHealth says it’s quitting 31 of the 34 states where it sells ACA policies. Humana is exiting 8 of 19 states and reducing its presence to just 156 counties, from 1,351 a year ago. Anthem hasn’t announced plans to change its participation in the program.
On Aug. 15, Aetna said it will stop selling Obamacare plans in 11 of the 15 states where it had participated in the program, reversing its plan to expand into five new state exchanges in 2017. “The exchanges are a mess as they exist today,” says Aetna Chief Executive Officer Mark Bertolini. “They’re losing a lot of money for a lot of people.”
Source: Obamacare’s in Trouble as Insurers Tire of Losing Money – Bloomberg
August 18, 2016
The American Action Forum (@AAF) today released a national survey of likely voters on health care. The poll was conducted by OnMessage Inc from July 5-7th. Overall the survey found that a majority believe private insurance companies are better at providing quality health care coverage than the federal government, 57 to 26 percent. When asked about affordability of health care, 48 percent say private insurance companies are better at providing affordable coverage.
The national survey also found that 61 percent oppose a single payer health care system, and 51 percent oppose the Affordable Care Act. These are significant as majorities believe that it has been unfair for the administration to change the rules of Obamacare for private health insurers and that harming private insurance may lead to a single payer system.
Source: AAF Releases National Survey On Health Care – AAF
August 18, 2016
And it is because of those losses that we are seeing what looks more than a little like the start of a health insurance death spiral in the exchanges. This is far from certain, and will depend in significant part on the results of the next open enrollment period, which starts later this year, as well as the decisions made by other health insurers under the law. But there are a number of warning signals to be watching.
We know what a health insurance death spiral looks like because we’ve seen them before, in states such as New York, New Jersey, and Washington. The experience in those states varied somewhat, but they all shared several essential qualities: The states put in place regulations requiring health insurers to sell to all comers (guaranteed issue), and strictly limiting the ways that insurance could be priced based on individual health history such as preexisting conditions (community rating). As a result, insurers ended up with large numbers of very sick customers who were very expensive to cover. Because they were subject to limits on how they could price health history, they responded by signficantly raising premiums for everyone. The new, higher premiums caused the healthiest, most price sensitive people to drop coverage entirely, which caused insurers to raise premiums further, resulting in yet more individuals dropping coverage, and so on and so forth, until all that remained was very small group of very sick, very expensive individuals.
Source: The Return of the Obamacare Death Spiral – Hit & Run : Reason.com
August 18, 2016
To begin to harness more fully the power of both consumerism and managed care in controlling costs, the rules for HSAs should be modified substantially to allow HSA holders to use their balances to purchase care from integrated systems in more creative ways than on a fee-for-service basis. For instance, HSA holders should be allowed to pay a fixed monthly fee to integrated plans to secure access to a wide variety of services, including access to electronic records and the ability to connect with their providers remotely. Moreover, HSA holders should be allowed to purchase options contracts allowing them to access an integrated plan’s network and care protocols in the event they incur large medical expenses, such as in the course of cancer treatment. Giving consumers more leeway over the use of their HSA resources will allow them to exert more pressure on those supplying medical services to them, and thus also allow them to get services provided to them in ways that they prefer and at prices they find acceptable.
Source: Bridging the Divide on Health Savings Accounts to Higher Value Health Care | RealClearHealth
August 18, 2016
Barack Obama’s signature health-care law is struggling for one overriding reason: Selling mispriced insurance is a precarious business model.
Aetna Inc. dealt the Affordable Care Act a severe setback by announcing Monday it would drastically reduce its participation in its insurance exchanges. Its reason: The company was attracting much sicker patients than expected. Indeed, all five of the largest national insurers say they are losing money on their ACA policies and three, including Aetna, are pulling back from the exchanges as a result.
The problem isn’t technical or temporary; it’s intrinsic to how the law was written. By incentivizing insurers to misprice risk, the law has created an unstable dynamic. Total enrollment this year will be barely half the 22 million the Congressional Budget Office projected just three years ago. Premiums, meanwhile, are set to skyrocket, which will further hamper enrollment. It isn’t clear how this can be fixed.
Source: The Unstable Economics in Obama’s Health Law – WSJ
August 17, 2016
Exhibit 1 compares insurers’ projected per-member-per-month (pmpm) medical expenses with actual medical claims for ACA-compliant individual coverage in 2014.10 Across the market, medical claims were 5.7 percent higher than projected ($429 vs. $406 pmpm). Some insurers did considerably worse than others. The quartile of insurers with the highest claims (75th percentile) underestimated their claims by an average of 35 percent, whereas the lowest-claim quartile projected their claims much more accurately, within 4 percent, on average, similar to the average claims underestimate of 6 percent marketwide.
Source: How Has the Affordable Care Act Affected Health Insurers’ Financial Performance? – The Commonwealth Fund