On February 11, 2016, the Congressional Budget Office (with the Joint Committee on Taxation) released a report on Private Health Insurance Premiums and Federal Policy. The report examines the effects of federal subsidies, fees, and taxes; federal regulations; and actions taken by insurers on health insurance premiums. In particular it considers how the Affordable Care Act (ACA) has affected health insurance premiums. The Congressional Budget Office (CBO) did not conduct any original research on these topics. Rather the report describes what economic theory would predict regarding these effects and the limited empirical work that has been done as to what has happened so far under the ACA.
Although much of this activity is about scaling — the idea that if you’re not big enough, you have to find someone bigger to merge with — I believe that much of what’s going on now is in response to the Affordable Care Act. The ACA lit the fuse on a trend that might have happened anyway, but was certainly sped along by the government’s push to insure all Americans. In short, we seem to be returning to a monopoly industry, where big companies are buying up smaller ones to achieve efficiencies of scale that not even the state-run nonprofit exchanges can touch.
To date, more than half a million Americans have lost coverage thanks to the failure of these co-ops. The reason? The co-ops took on far too many customers at artificially low premiums, and, as the American Enterprise Institute and the Galen Institute noted earlier this year, are drawing down “unspent loan funds to pay medical claims.”
Despite mounting failures, the Obama administration has been unwilling to change course. Politico Pro has reported that state and federal regulators let some of the co-ops “reclassify certain loans as surplus, a move that financial analysts say will make the health plans’ balance sheets look better and potentially keep them from shutting down.” In other words, to hide their debts and project false solvency—until they, too, go under.
In sum, of the 24 Obamacare co-ops funded with federal tax dollars, one (Vermont’s) never got approval to sell coverage, a second (CoOportunity) has already been wound down, and nine more will terminate at the end of this year.
Quite candidly, anybody dumb enough to take the government money under these circumstances wasn’t going to be smart enough to pull it off.Let me also suggest that these struggling Obamacare co-ops are tantamount to the canaries in the Obamacare coal mine.These plans are exclusively in the business of the Obamacare insurance exchanges. If you want to segregate the Obamacare insurance business model from the overall insurance business to examine it, the co-ops are pure Obamacare.Just how well have all of the co-ops done?As the Washington Post recently reported, of the 23 Obamacare insurance co-ops in business on June 30, 2015, each of them charted in the article, 20 of them were losing money–most of these relatively tiny insurance start-ups showed staggering losses in the range of $4,000,000 to $50,000,000!
Iowa’s co-op may be the first to implode, but it is not the only one facing insolvency. By the end of 2014, CMS had furnished approximately $2.5 billion in loans for co-ops. According to A.M. Best, an insurance rating firm, all but one co-op had reported operating losses in 2014.
If politicians have learned nothing else in the wake of ObamaCare and the government’s ill-conceived foray into the health insurance marketplace, they certainly know now that the health care sector is highly complex, that government is ill equipped to understand it, let alone manage the system. It is time for politicians and bureaucrats to stop interfering with health care.
Even though it’s only the beginning of 2015, insurers are already starting to think about 2016 rate filings. Using 2014-2015 Health Insurance Marketplace data, we looked for correlations between silver plan premiums and variables like the number of carriers and plans in a rating area, available industry metrics, and the structure of provider networks in each rating area. We focused our analysis on the second-lowest silver plan offered in each market and discovered some interesting findings.