How Much Will You Pay for Health Care in 2015? What You Need to Know About Healthcare Inflation-Part 1

 

Probably you have seen headlines like this one: “O-Care premiums to skyrocket.”

The warning, which was posted on The Hill, seemed designed to cheer conservatives distraught by Obamcare’s enrollment numbers. It began by announcing that next year, “premiums will double in some parts of the country. The sticker shock will likely bolster the GOP’s prospects in November and hamper ObamaCare insurance enrollment efforts in 2015.”

Where did the reporter get her information?  The story is based on interviews with “health insurance officials.”

Why would they issue such dire predictions? Perhaps they are trying to soften us up so that when insurance rates rise by “only” 7% to 10%, we’ll be surprised and grateful? (This is just a thought.)

The truth is that there is absolutely no reason to believe the same old, same old, fear-mongers who claim that in 2015, rates will spiral “by 200% to 300%.”

But what about those who predict double-digit hikes?  Wellpoint, the biggest commercial insurer in the Exchanges, recently told Bloomberg that it may ask for “double-digit plus” increases when it proposes 2015 rates sometime next month.

Wellpoint can propose whatever it wishes, but I very much doubt that state regulators would accept such stiff increases. A combination of regulation and competition will keep a lid on premiums both in the Exchanges, and off-Exchange, just as it did this year.

My guess is that, in most states, rates will rise by no more than 2% to 4%. Meanwhile, government subsidies will climb to cover those increases for most who buy policies inside the Exchanges. (This year 80% of shoppers who purchased insurance in the state marketplaces received tax credits to help with premiums.) Folks who purchase coverage off-Exchange won’t receive subsidies, but carriers selling policies to individuals outside the government’s online marketplaces will have to compete with prices inside the Exchanges.

Why am I so optimistic?

The Underlying Cost of Medical Care Is Slowing

Americans have become so accustomed to hearing about “runaway health care inflation” that most do not realize that we have finally “broken the curve” of rising health care costs.

Granted, for most of this century, rates soared: “From 2000 to 2009, health insurance  premiums climbed 84%,” Zeke Emanuel, a former White House healthcare adviser and author of Reinventing American Healthcare: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System., recently told NBC’s “Meet the Press.”

By contrast, “for the past three years, health care cost growth has dramatically slowed and is just about even with growth in the economy. Some of this is due to lingering effects of the recession in 2008,” he added. “But a part of it is undoubtedly due to the ACA.”

Drew Altman, president of the Kaiser Family Foundation, points out that, despite the aging of the population, ”the Congressional Budget Office projects that Medicare will cost significantly less in the future than previously thought,in part because of the ACA’s changes to Medicare’s payments. “  (As I have explained, those cuts do not reduce benefits, but they do force hospitals to cut waste and provide better value for our Medicare dollars.

Both in the public sector and in the private sector, “Overall health spending is growing at the slowest rate in 50 years,” Altman observes,  (dating back to when the government first started tabulating health expenditures.)”

“The key for the future is not to eradicate premium increases entirely,” Emanuel adds. The goal “is to make sure [that these increases] aren’t Excessive.”

He stresses that there is still much to be done to rein in healthcare spending. But for the moment “the exchanges are stable,” says Emanuel. “Premiums are likely to rise a little but not excessively.”

If you don’t believe Emanuel and Altman, take a look at the graph below, comparing outlays for all medical services (the orange line) to the PCE (personal consumption expenditures–the blue line) from 2009 to 2014. As you can see annual spending on healthcare services is now growing by well under 1% a year. (For a larger version of the graph, click on the link above.)

ifi0rzbQK9cU   bloomberg chart

Bloomberg News used the graph earlier this week, to illustrate a story that lays out some critical and little-known facts:

Prices “for medical services, which make up the biggest share of health care costs, have eased in the past two years. From February 2013 to February 2014 physician fees edged up just “0.2 percent–down from a 1.6 percent rise 2012,” Bloomberg reported, and “the cost of nursing home care rose by only 0.3 percent,” compared with “1.8 percent two years earlier.”

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Obamacare Enrollment, Including Medicaid, Heads for 14-20 Million

Revised: April 12

Charles Gaba, who has become the go-to-guru for Obamacare enrollment numbers, now predicts that by April 15, 7.09 to 9.75 million Americans will have purchased health insurance in the Exchanges. 

This is in line with the back-of-the-envelope estimate that he offered a week ago: “a nice round 8 million.”  (In parentheses, he suggested:  Perhaps a little higher (1M even?)., and then struck that thought.  “As always,” he noted, “I’ll be more than happy to be proven wrong, as long as I’ve undershot the mark.”

 

To that 7.09 to 9.75 million, he now adds 2.09 million who he is certain have bought comprehensive coverage outside the Exchange, plus an additional 5.7 million who, according to a Rand study published earlier this week, may have signed up  off-Exchange. Finally, Gaba estimates that 5.23 million to 7.29 million Americans have enrolled in Medicaid or CHIP. 

As of April 12, this brings the total number who will have insurance that meets the Affordable Care Acts (ACA’s) high standards to roughly 14 million to 20.2 million.

When Gaba first reported on the Rand report, he acknowledged that Rand’s numbers “were based on a survey” and “surveys include margins of error.”

Gaba has gained his reputation by being meticulous—and cautious. Typically, his estimates have been conservative. Given that track record, I suspect that by April 15, we will find that well over 14 million people have benefited from Obamacare. If pressed, I would guess 17 million.

At this point, you may be wondering: But don’t we need the new enrollees who are purchasing policies off-Exchange to join the state marketplaces in order to spread the cost of coverage among as many people as possible?

The answer is “No.”

A little-known provision in the ACA stipulates that if a carrier sells policies to individuals both in the state marketplace and in the private market, the insurer must view those customers as part of one risk pool, and price their policies accordingly. Together, they will  share the risk of becoming sick, while also sharing the cost of insurance that guarantees everyone access to care. All other things being equal, the larger the pool of people who buy coverage both on and off the Exchanges, the lower the risk– and the lower the cost for all of them.

“All other things being equal” includes whether the new people jumping into that pool are healthy. Recent evidence suggests that the new entrants are, in fact, younger, and as a result, more robust than those who signed up earlier.

In future posts, I’ll take a closer look at that pool, and explore how much you are likely to wind up paying for insurance next year.

 

 

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Obamacare Enrollment Hits 7 Million, Putting Downward Pressure on 2015 Premiums; Word-of-Mouth Spreads the Truth

(Updated March 31)

As the “train wreck” called Obamacare pulls into the station it’s becoming clear that some 7 million Americans are signing up to purchase insurance in the Exchanges. Ten days ago I went out on a limb and predicted that we would hit 7 million, if not by March 31, by early summer. Now it appears that we’ll break through that target by midnight.

Seven million was the Congressional Budget Office’s (CBO’s) initial estimate, but when the roll-out proved rocky, the administration lowered its expectations to 6 million. Reform’s opponents groused that this still was too optimistic, and before long the consensus estimate fell to 4 to 5 million. (Conservatives, who had helped lower the consensus, then accused Democrats of moving the goal-post to make it easier to claim success.) 

                             Younger Americans Join the Pool

Who are these last-minute shoppers? According to the Wall Street Journal,carriers are beginning to report that many are under 40.  Today, more insurers confirmed the trend. This should come as no surprise.

We always knew that people in their 50s and 60s would join the Exchanges first. Healthy 20-somethings and 30-somethings who rarely see a doctor would be in no rush to sign up. Why begin paying premiums before you have to? 

                                          Momentum Builds

Now, younger Americans are  jumping into the pool, and, most importantly, the pace of enrollments is building. Friday, March 28, Charles Gaba, the “numbers Geek” who has correctly predicted earlier enrollment milestones, wrote: “We’re in uncharted territory. . . Things are moving VERY quickly now, and events are quickly overtaking my ability to keep up.”  Yesterday (Saturday, March 29), Gaba hiked his March 31 estimate to 6.7 million, up from 6.22 million earlier in the week.

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Subsidies: Would You Qualify? Consumer Reports Has A User-Friendly Tool That Will Tell You

 

Check out this online tool from Consumer Reports. It allows you to quickly and easily find out if you–or a relative–would be eligible for a subsidy. A great many young people don’t realize how little insurance would cost after applying the tax credit. Do them a favor, and find out for them. https://www.healthtaxcredittool.org/

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Under Obamacare, Will Out of Pocket Spending Be Higher?

Not long ago, the Fear-Mongers were warning that under the Affordable Care Act, insurance premiums would spiral, causing “sticker shock.” Then the rates were published, and it turned out that, thanks to transparent markets in the exchanges, insurers had to compete on price, and premiums are lower than expected.  

But don’t worry, reform’s opponents haven’t run out of talking points. (I expect that long after most of the country has begun to enjoy the benefits of Obamacare, out-of-touch conservatives still will be muttering to themselves – rather like Japanese officers who held out in the jungles of the Philippines after WW II ended, unable to accept the fact that they had lost the war.)

In search of a new meme, they have latched onto the idea that, in the exchanges, customers will face “Staggering Out-of-Pocket Costs.” Sure, premiums may look low they say,, but wait until you try to use the policy and find yourself laying out $6,000. . Not long ago, Fox News summed up the argument: If the policy you bought in the individual market is cancelled because it doesn’t conform to the ACA’s rules, and you are forced to purchase coverage in an exchange, co-pays and deductibles will soon make you realize that the ACA is really “The Unaffordable Care Act.” 

Fox picked up the theme from a Bloomberg News story that went viral:“Obamacare Deductibles 26% Higher Make Cheap Rates a Risk,”  the Bloomberg headline screamed. As evidence, Bloomberg pointed to a survey of seven states, done by HealthPocket Inc., that compares the average deductible a consumer will face if he purchases a Bronze Plan in an Obamacare exchange to the average deductible in the private-sector market where 5 percent of Americans have been buying their own coverage. (These are the policies that are disappearing because they don’t meet the ACA’s standards.)

It turns out that the survey greatly exaggerates out-of-pocket spending in the Exchanges by focusing only on Bronze plan.  Meanwhile, the media ignores the most important number: what is the Maximum that an insurer can ask you to pay out of pocket?

The problem with many of the policies that are now being cancelled is not just that they were studded with holes  (some didn’t cover hospitalization; some didn’t cover chemo), but that in many states, a family could be asked to pay $30,000—or more—in co-pays and deductibles. . In a few states, there was no cap on the a patient’s liability.I This is how families lose their homes.

I’ve written about this here on healthinsurance.org. Read the entire post and, if you like, come back here to comment.

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Did You Know That 6 to 7 Million Americans Will Qualify for “Free” Health Insurance In the Exchanges? “Affordability May Not Be a Roadblock” to “Signing Up 7 Million” in 2014 –Credit Suisse

If you know someone who is uninsured, or buys her own insurance in the individual market– and lives in Texas, North Carolina, Missouri, Oklahoma, Louisiana, Mississippi, or Alabamachances are greater than 1 in 3 that under Obamacare she will qualify for health insurance that will cost her nothing. That’s right—her government tax credit will cover the entire premium.

It gets better. After shopping the state Exchanges during the first two weeks of October, McKinsey & Co, a leading global management consulting firm, discovered that people who are currently uninsured (or who buy their own insurance) in Florida, Wisconsin, Georgia, South Carolina, Tennessee, Virginia, Maine, Indiana, Kansas, Nebraska, Utah, Idaho, Montana or Alaska– stand a 1 in 4 chance of qualifying for a $0 policy.

How can that be? McKinsey explains that their income will makes them eligible for a government subsidy that will be larger than the policy’s premium.  Americans earning somewhere between $11,490 and 400% of the FPL ($48, 950 for an individual, $62,040 for a couple, $94,200 for a family) will receive subsidies. The lower your income, the larger it will be, and the more likely it is that your premium will be Zero .

This table from Credit Suisse reveals that in many states, uninsured Americans earning less than 175%  of the Federal Poverty Level (roughly $20,100 for an individual; $21,750 for a couple;  $34,170 for a family of three;  $41, 200 for a family of four) will be able to find zero-premium plans. Even if you earn somewhat more, it’s well worth the time it will take to check with your state marketplace.  You may discover that while coverage isn’t free, your subsidy will bring the cost down to as little as $20 a month.

Credit Suisse analyst Ralph Giacobbe agrees that roughly “6.5 million Americans … will be eligible for a $0 premium plan.” As a result, he believes that “affordability may not be a roadblock” to achieving the Congressional Budget Office projection that 7 million people will buy insurance in the exchanges in 2014

“Simply put, we don’t see any logical reason why anyone in this population wouldn’t take free healthcare coverage vs. remaining uninsured.”

The only question is this: How many people will hear about the free plans? Can we count on the media to inform the public? (Hat tip to the New York Times for publishing a front-page story about the McKinsey research.) Now, I would love to see the story on FOX – and in Forbes.

You can help spread the word. Do you know someone who is single, earns somewhere between $11, 490 and roughly $20,100 (175% of the FPL) and does not  have employer-sponsored insurance?  A graduate student?  Your cousin’s son?

Do you know   a family of three with income under $34,170 (175% of the FPL)  Perhaps the stay-at-home Mom down the street who just had a baby?

Good News for 20-Somethings and 30-Somethings

McKinsey reports that about half of those who will be able to purchase zero-premium insurance will be under 39 years old.

I originally published this story on  the Health Insurance Resource Center Blog. Click  there to  read the rest of the post—and find out more about the cap on the  co-pays and deductibles that someone with a $0 premium plan would pay.  

You can comment on the Health Insurance Resource Center Blog, or  you come back here to respond.

 

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The Truth About Obamacare’s Exchanges

          Paul Krugman: “There are two remarkable things about this kind of doomsaying. One is that the doomsayers haven’t rethought their premises despite being wrong again and again — perhaps because the news media continue to treat them with immense respect.”

If you Google “Obamacare,” “Exchanges,” and “Disaster,” more than 20 million articles will pop up.

One month into a six-month enrollment process, the Media Pundits have spoken.

In truth, there are two tales to be told: one that is getting widespread coverage, and one that is not.

The stories that you are Not hearing come from folks like Michael Cadigan, the president of a New Mexico law firm who enrolled his firm’s four employees the day his state’s Exchange opened. “I thought it was going to be an administrative nightmare,” he confesses. Instead, he quickly found a policy “that will cost $1,000 less a month than I’m currently paying.” 

Or, Randall Bennett: His family will be paying more for the coverage he signed up for in Utah’s Exchange, but it will be significantly better than what they had before. This year, Bennett reports he has been paying a $420 monthly premium with a $2,000 annual deductible. Next year, he’ll be paying a $720 premium, but the deductible will be only $500 and his family will be getting maternity and dental coverage — something they couldn’t  get in the individual market before Obamacare came along.

As for the application process, Bennett says: “Before, trying to get insurance was so difficult that surprisingly even with all of the bugs, I still found [the Exchange website] simpler (In the past, people attempting to buy their own coverage in the individual market had to provide carriers with detail medical information, in order to prove that they were not suffering from a pre-existing condition. Under Obamacare, that isn’t necessary. Insurers can no longer use your medical records as an excuse to jack up your premiums.

“So for us this is a huge win,” Bennett concludes, “because we’re paying what we think is fair. And yes it’s more than before, but we actually have coverage that we like now.”

As of October 24, Cadigan and Bennett were just two of some 700,000 Americans who have filed applications in the Exchanges. The truth is that Obamacare’s websites are working– though not in all states.

Make no mistake: enrolling millions of American in Obamacare represents an enormous challenge. But we know that it can be done — because it is being done, and done well– in many states.

Unfortunately this is not a story that sells newspapers, especially when a program is as controversial as Obamacare.

State vs. Federal Exchanges

The marketplaces that are working best are in states that chose to set up their own Exchanges.

Originally, conservatives in Congress argued that states should be able to construct—and control– their own online sign-up sites. The Affordable Care Act offered them that opportunity.

But after thinking it over, 26 states (24 of them led by Republicans) refused. In these 26 states, it was left to the Feds to run “Healthcare.gov.”

Health IT pioneer Fred Trotter says he is “not at all surprised” by what happened next: Computers and human navigators have been overwhelmed by the sheer size of a sprawling project. Technical glitches have created virtual gridlock.

“When you get a tremendous amount of traffic going to any site on the internet a single computer can’t handle it,” Trotert told Ezra Klein in a recent interview. “You have to have more than one computer sharing a task. At modern sites like Amazon and Ebay . . . the main innovation they’ve pioneered is using lots of computers at the same time to answer one query.”

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Insurers “Had a Seat at the Table” when Reformers Hammered Out the ACA, but Things Didn’t Work Out Quite As They Expected . . .

What This Means for Health Insurance Stocks–and Your Premiums

When Congress passed the Affordable Care Act (ACA) in 2010, liberal critics feared that the Obama administration had “cut a deal” with for-profit insurers.  Single-payer advocates were particularly incensed when reformers invited the insurers’ lobbyists to the table to help hammer out the details of the legislation.  Some charged that, in return for the industry’s support, the administration agreed to a mandate that would force 30 million uninsured to buy private-sector insurance (or pay a penalty,) thus guaranteeing carriers millions of new customers, and billions in new revenues.

“It pays to be one of the few sellers of a product the government is going to force everyone to buy and provides subsidies to help them do it,” one Obamacare opponent sniped. 

Why Health Industry Insiders Were Offered Seats at the Table

At the time, I didn’t believe that the administration was selling out to the health care industry. Reform’s architects offered insurers, drug makers and device-makers seats at the negotiating table, in part because because they hoped to persuade them to help fund reform – and they succeeded.

Ultimately, the industry agreed to shell out over $100 billion in new fees and taxes to help fund the legislation. Those contributions are critical to financing subsidies for low-income and middle-income Americans.

The Obama administration also did not want to watch re-runs of the “Harry & Louise” television ads that helped torpedo “HillaryCare.” Here too, they prevailed.  In a new series of 2009 ads, the make-believe TV couple were all smiles: “A little more cooperation, a little less politics, and we can get the job done this time,” Louise declares.

Still, some feared that the administration was giving away the store. “No wonder the cost of reform keeps going up and up and up,” said  Bill Moyers.  “Could it be” he asked, “that Harry and Louise are happier because, this time, they’re in on the deal?” 

              But Didn’t the  Administration Capitulate On the “Public Option”?

Skeptics on the Left also believed that  reformers agreed to quash the “public option”—a government insurance plan that would compete with private sector carriers.
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Take Your Time—They Are Not Going to Run Out of Policies!

The stampede into the Exchanges only proves that the people who said that “Young Invincibles” don’t want insurance –or that older Americans won’t be able to afford the Exchange’s offerings –were wrong.

Think Progress offers snapshots of folks like Butch Matthews who have signed up for Obamacare in the past two days.

A life-long Republican, the 61-year-old Matthews was paying  over $12,000 a year for health insurance that carried a $10,000 deductible. The former small business owner had two stents placed in his heart in 2006, and the policy didn’t even cover his medication and doctors’ visits. But that was all he could find in the private sector’s individual market—until Tuesday, when he discovered that after applying his government subsidy, the silver plan sold in his Arkansas Exchange will cost him nothing. And the deductible is just $250.

“It’s a lot better plan,” said Matthews. When he goes to the doctor he will no longer have to shell out a $150 co-pay. Instead, he will owe just $8.

Until Tuesday, Matthews had been extremely skeptical about Obamacare. So what would Matthews tell other Americans who are just as skeptical today? 

“I would tell them to learn more about it before they start talking bad about it. Be more informed, get more information, take your time and study and not just go by just what you hear on one side or the other. Actually check the facts on it.. . I still am a very strong Republican, but this… I’m so happy that this came long . . .”

Why was Butch Matthews so surprised to discover how much Obamacare would help him? Because when it comes correcting the lies that conservatives have been spreading about the Affordable Care Act, the media has done a miserable job. From the beginning, rather than reporting on the content of the legislation—and the ideas and values behind reform, most pundits focused on the political debate, as if it were a sporting event. Who is  winning? Who is losing? This was far easier than delving into the details of the law.

Now, however, millions of middle-income Americans are beginning to find out for themselves what reform will mean for their families. As I have argued in the past: once they know what is actually is in the legislation, they will like it.

                            Obamacare Proves Too Popular

Never at a loss for words, the nay-sayers now are claiming that the computer glitches that we’ve seen during the first two days of enrollment serve as evidence that Obamacare is a disaster

No, the delays simply prove that modern technology is far from perfect– something I am reminded of each day. (I recently bought a new computer, complete with a new version of Windows.)  But over time, we find our way around computer glitches

Shouldn’t  the Exchanges have been prepared for the crowds? No, the polls had told Exchange planners that most people knew little about Obamacare and had no idea that they could enroll on Oct. 1. We were told that the majority were not even aware that they might receive government subsidies. (Now it appears that critics exaggerated what a bad job the government was doing when it came to publicizing the marketplaces. )

More importantly, the technical snafus say nothing about the benefits that people like Butch Matthews will receive.  In six months, if a great many Americans are complaining that the policies offered in the Exchanges are too expensive—or  just are not very good—then we might say that Obamacare is running into trouble. (Though it will probably take two years to make a judgment as to whether it is a success.)  What  matters is the quality of the product reform is delivering, not whether the process of enrolling people goes without a hitch.     

 Kentucky, the Exception that Proves It Can Be Done

Moreover, while the Federal Exchanges have been having more than their share of problems (perhaps because Washington wound up having to take responsibility for setting up the marketplaces in so many places), in  some states enrollment is proceeding smoothly.

In Kentucky, of all places, some 11,879 people already have enrolled for coverage–,and paid their first month’s premium, to boot.  (Hat-tip to Wonkblog’s Sarah Kliff.)

Governor Steve Beshear, a second-term Democrat who is also a technocrat, deserves the credit. He managed to pull this off despite furious opposition from state Republicans such as Kentucky Senator Mitch McConnell, the minority leader who is up for reelection next year  If the citizens of the Bluegrass state like Obamacare, could this wind up hurting McConnell’s chances? One can only hope.

Up until now, Alison Lundergan Grimes, the Democrat who will be challenging  McConnell, has been wisely reticent on the question of reform. When pressed by reporters, Grimes has indicated that she is troubled by some parts of the Affordable Care Act and would push to “fix” some of its mandates on businesses, but not repeal the entire law

In August she said “Let’s not throw out the baby with the bath water,” noting that the law prohibits insurance companies from cancelling coverage for people with pre-existing medical conditions and allows young adults to stay on their parents’ health insurance plans until they turn 26.

If Kentuckians embrace Obamacare,no doubt she will step forward to firmly endorse reform.

“I think it is probably smart politics,” U.S. Rep. John Yarmuth, D-Louisville told the Lexington Herald-Leader.  I think she has the opportunity to wait and see how it’s received. When she starts to say positive things about it, the climate will be better for her to do that.

I agree. In Kentucky, the Affordable Care Act already has a strong supporter–Governor Beshear,  Grimes’ job is to drive Mitch McConnell out of Congress.

                              Why You Don’t Want to Enroll Now

In coming months, the Federal Exchanges will catch up with Kentucky, They have plenty of time. The open enrollment period lasts for six months –until the end of March, 2014.

Americans who plan to purchase their own insurance in the state marketplaces should focus on the fact that there is NO RUSH to enroll.

If you want new insurance by January 1, you don’t need to enroll until  December 15. Of course you probably don’t want to wait until the last minute. You need time to look at the plans, and ask questions.

But keep in mind that you have to pay your first premium 30 days after you enroll. If you sign up on October 15, that premium is due November 15—even though your insurance will not begin until January 1.)

My suggestion: if you don’t want to be part of the current madness, wait a few weeks.  Let the people running  the Exchanges get some of the kinks out of the system.

 

 

 

 

 

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