Tag Archives: health insurance exchanges

Government Buries Evidence of Poor Access to Care under Obamacare

From John R. Graham:

Thank providence for USA Today, which has given us yet another story describing how poor access to health care is under Obamacare.

People who fell for navigators’ sales pitches and signed up for Obamacare are discovering that it is junk insurance:

“The exchanges have become very much like Medicaid,” says Andrew Kleinman, a plastic surgeon and president of the Medical Society of the State of New York. “Physicians who are in solo practices have to be careful to not take too many patients reimbursed at lower rates or they’re not going to be in business very long.”

Kleinman says his members complain rates can be 50% lower than commercial plans.

“I definitely feel like a bad person who is leeching off the system when I call the doctors’ offices,” she says. Shawn Smith of Seymour, Ind., spent about five months trying to find a primary care doctor on the network who would take her with a new, subsidized silver-level ACA insurance plan.

Note: This person had a silver plan, not a bargain basement bronze plan.

More: Government Buries Evidence of Poor Access to Care under Obamacare | Health Policy Blog | NCPA.org.

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Despite ObamaCare Supporters’ Claims, Health Insurance Plans Prior to ObamaCare Exchanges Were Neither ‘Crappy’ Nor ‘Substandard’

From David Hogberg at the National Center for Public Policy Research:

When millions of people in the individual health insurance market lost their health plans in late 2013, ObamaCare supporters claimed those lost plans were “substandard” or “crappy.” However, they failed to support that contention.

This study examines the claim that the policies on the individual market were inferior in quality to those on the ObamaCare exchanges. First, it compares the premiums and the size of the deductibles as well as maximum out-of-pocket costs of policies on the individual market prior to the exchanges to those of current polices on the exchanges. Second, it examines the quality of provider networks by comparing the number of plans that are HMOs versus those that are PPOs in the individual market prior to the exchanges and those now on the exchanges.

The study finds that there were many policies on the individual market that had lower premiums and lower or equal deductibles and out-of-pocket maximums than the cheapest plans now available on the exchanges. It also finds that the individual market prior to the exchanges offered a greater choice of hospitals and physicians since it contained far more PPO policies than HMO policies, whereas the exchanges offer more HMO policies.

Read the whole study: Despite ObamaCare Supporters’ Claims, Health Insurance Plans Prior to ObamaCare Exchanges Were Neither ‘Crappy’ Nor ‘Substandard’.

Via the National Center for Policy Analysis.

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#ObamaCare Exchanges Recklessly, Often Unlawfully, Throwing Taxpayer Money At Health Insurance Companies

Michael Cannon at Cato:

This is part of a deliberateconsistent strategy by the Obama administration to throw money at individual voters and key health care industry groups—lawfully or not—to buy support for this consistently unpopular law.

More: ObamaCare Exchanges Recklessly, Often Unlawfully, Throwing Taxpayer Money At Health Insurance Companies | Cato @ Liberty.

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#ObamaCare: Taxpayers bailout insurers, and more uninsured within 10 years?

Michael Ramlet writes:

We estimate that within 10 years, the number of uninsured Americans may increase by 10 percent. At the same time, premiums will rise faster than federal subsidies. The latter problem will be most severe when insurers release their 2017 rate increases in the summer and fall of 2016—perhaps the most awkward timing for the law’s supporters.

More: A 10-Year Prediction for the Affordable Care Act – NationalJournal.com.

See also Risky Business: Will Taxpayers Bail Out Health Insurers? by John R. Graham.

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#ObamaCare Update: premium increases, paperwork troubles, competition lowers prices, Congress exempt from own rules

From a recent NCPA Washington Update:

As the implementation of Obamacare moves forward, more people are buying insurance and many of the early problems that plagued the website seem solved. But public approval ratings remain dismal. Maybe it is the complex labyrinth of paperwork. Or the rising cost of premiums. Many businesses are still coping with the effects of the new health care law, while many individuals are still trying to send the right documents to the government.

It turns out that health insurance premiums tend to be more affordable in states with more competition among insurance companies. That is a predictable outcome based on what we learned in Econ 101. Another predictable conclusion: Congress will always try to play by their own rules. You may remember that the Obama Administration exempted Congress from a provision in the law that requires members of Congress and their staff to purchase health insurance in the Obamacare exchange without a taxpayer subsidy. That’s why Rep. Phil Gingrey (R-GA), Sen. David Vitter (R-LA) and other Republicans opposed the exemption. Now there are a group of Democrats who are introducing legislation that would require Congress to play by the same rules as everyone else. Just in time for the election.

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Left on #ObamaCare: high insurance premiums don’t matter, as other people will pay for it

At Forbes, Avik Roy writes:

Over the past twelve months, there has been an energetic debate among health policy researchers about the extent to which Obamacare will increase the underlying cost of individually-purchased health insurance: what observers have come to call “rate shock.” Yesterday, the Manhattan Institute published the most comprehensive study yet on the topic, analyzing premium data from 3,137 U.S. counties, and finding an average rate hike of 49 percent. In response, left-wing bloggers are trying out a new talking point: that rate shock doesn’t matter, because taxpayer-funded subsidies will bear the higher costs.

There are a number of reasons why the underlying cost of health insurance matters.

Read more: Left: Obamacare Rate Shock Doesn’t Matter, Because Other People’s Money Will Pay For It – Forbes.

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As Expected, #ObamaCare Motivates Insurers to Shun the Sickest People

John R. Graham writes:

A patient with HIV/AIDS can expect to pay over $1,000 out of pocket for medicines, if he buys a policy on the ObamaCare health insurance exchange in Florida.

“woman-in-hospitalAffordable”? Surely not. This perceived injustice has caused legal activists to file a lawsuit against four insurers, which offer plans in the Florida exchange, alleging discrimination.

Readers of this blog know that we have long warned against this consequence of ObamaCare. Insurers are not allowed to charge premiums appropriate to applicants’ expected medical claims. …

An ObamaCare Silver policy must pay 70 percent of expected medical costs, while covering 100 percent of “preventive care” (as defined by the federal government). However, the plan is designed for the average patient. So, it is easy for a health plan to design a plan that imposes very high medical maintenance costs on very sick, chronically ill people. High co-payments or co-insurance for prescriptions is one obvious method.

Our prediction: There will be many more such lawsuits.

Read more: As Expected, ObamaCare Motivates Insurers to Shun the Sickest People | John Goodman’s Health Policy Blog | NCPA.org.

In February, Graham blogged about this article from The Hill, which reports: “Consumers who use specialty medications may face higher costs on ObamaCare’s marketplace plans, many of which include co-insurance rather than copayments for the drugs, a new analysis warned.”

Last week, Graham illustrated one more example of insurers avoiding sick patients, this time in relation to how insurers use ObamaCare subsidies:

[P]lans apply more of the subsidy to the deductible, somewhat less likely to apply it to specialist charges, and much less likely to apply it to the most expensive tier 4 drugs on the formulary. What this means is that generally healthy patients who go to see their primary-care physician occasionally, but need no specialist care or specialty prescriptions, are most likely to benefit from the cost-sharing reductions. Those who need specialist care and, especially,  tier 4 drugs will be less likely to benefit.

Back in 2010, Peter Suderman wrote about how insurers tailor their plans to attract the healthy & avoid the sick:

Indeed, because insurers will be limited in terms of how they can charge based on health risk factors, the new rules may encourage plan providers to avoid investing in resources that help the sick.

For example, a 1997 New England Journal of Medicine study looked at billing records for elderly Americans participating in Medicare HMOs in Florida. The study found that, despite exchange-like regulations guaranteeing access to any HMO plan and prohibiting insurer cherry picking (or “medlining,” as it’s sometimes called), insurance companies managed to lure in the healthiest—and cheapest—patients, while leaving the sickest, most expensive patients on publicly funded Medicare.

As does John Goodman, writing about community rating:

When premiums are regulated so that they cannot reflect expected costs, four things will happen:

  1. On the buyer side, people who are under-charged will over-insure and people who are over-charged will under-insure. This is basic economics. If the price you are asked to pay is artificially low, you will buy more than you otherwise would; if the price is artificially high, you will buy less. If you are sick and require a lot of medical care but can pay the premium ordinarily charged to a healthy enrollee, for example, you will likely choose the richest plan you can find.
  2. In order to avoid attracting high cost enrollees, health plans will respond by scaling back their benefits and their provider networks until the richest plans look pretty much like every other plan. In the individual market today, in most states you can buy a BlueCross plan that covers almost all doctors in your area and practically every hospital, including all the best hospitals. I predict those plans will never see the light of day inside the (ObamaCare) health insurance exchanges. See Monday’s Health Alert on the race to the bottom with respect to access to care.
  3. At the same time, health plans will seek to attract the healthy. Of course, to a certain extent they are doing that today. But with an electronic exchange in which healthy people tend to buy on price and sick people tend to buy on benefits and software that makes it easy to do those things, the insurers will be even more pressured to reconfigure their offerings to make them more attractive to the healthy and less attractive to people who need medical care.
  4. Finally, the perverse incentives do not end at the point of enrollment. They continue. Health plans will have perverse incentives to over-provide to the healthy (to keep the ones they have and attract more of them) and to under-provide to the sick (to avoid attracting more of them and encourage those they have to go elsewhere).

See also this Reuters article: “Chronically ill facing high drugs costs under U.S. health law“:

Insurers say they had to move toward greater cost-sharing due to higher prices for new drugs, some of which can cost more than $100,000 annually per patient.

Researchers also say the higher rates help insurers bankroll low monthly premiums to attract healthy young enrollees.

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