Sans Trump sabotage, exchange premiums would be dropping

The exchanges have had quite a ride. As recapped in more detail in the The Story of the Exchanges, they launched with premiums well below expectations and remained relatively stable from 2014-16. Then in 2017 there was a correction for initial underpricing, but it turned out to be an overcorrection. But by then Trump was in office and deliberate decisions on the part of his administration artificially drove up premiums for 2018 and will again for 2019 in most places. So instead of the falling premiums we would've seen under a sane administration, we've seen further premium hikes.

Brookings has tried to tease out what should be happening next year in "How Would Individual Market Premiums Change in 2019 in a Stable Policy Environment?"

Indeed, under my base assumptions, I estimate that the nationwide average per member per month premium in the individual market would fall by 4.3 percent in 2019 in a stable policy environment. This estimate is subject to some uncertainty, primarily because of uncertainty about underlying individual market claims trends and about the margins insurers are likely to target for 2019. However, I estimate that average premiums would have declined in a stable policy environment under a range of plausible alternative assumptions.

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Trump is ruining America.. We must stop him..

ReMarx said:

Trump is ruining America.. We must stop him..

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I am not a Trump supporter, but he does stir the pot and that I like to see. Our Nation has been on a downward spiral for a long time. I'm not sure that either great intellect or hyper-partisan policies can solve our problems. The money problems will come home to roost. Perhaps the bankruptor-in-chief will be useful after all. Experience and the obvious predilection of Trump to use the bankruptcy is a humongous threat to Nations holding our debt. My guess is he will try to leverage a write down because that is his style and past record.
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Greenbeard said:

The exchanges have had quite a ride. As recapped in more detail in the The Story of the Exchanges, they launched with premiums well below expectations and remained relatively stable from 2014-16. Then in 2017 there was a correction for initial underpricing, but it turned out to be an overcorrection. But by then Trump was in office and deliberate decisions on the part of his administration artificially drove up premiums for 2018 and will again for 2019 in most places. So instead of the falling premiums we would've seen under a sane administration, we've seen further premium hikes.

Brookings has tried to tease out what should be happening next year in "How Would Individual Market Premiums Change in 2019 in a Stable Policy Environment?"

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Red:
And thus has been laid the foundation of yet another Trump-engineered problem that Trump will "solve."

Trump promised better healthcare for all of us at lower prices.

I know he keeps his promises. Every day his fans tell me so.

Greenbeard said:

The exchanges have had quite a ride. As recapped in more detail in the The Story of the Exchanges, they launched with premiums well below expectations and remained relatively stable from 2014-16. Then in 2017 there was a correction for initial underpricing, but it turned out to be an overcorrection. But by then Trump was in office and deliberate decisions on the part of his administration artificially drove up premiums for 2018 and will again for 2019 in most places. So instead of the falling premiums we would've seen under a sane administration, we've seen further premium hikes.

Brookings has tried to tease out what should be happening next year in "How Would Individual Market Premiums Change in 2019 in a Stable Policy Environment?"

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You know.. you have to really ask why these things aren't more reported in the media. There has been a long history of specific things that republicans have done.. to undermine the competition an success of healthcare insurance markets in exchanges.. (and I am a republican)..

But not much seems to make the media.

Do you think its because they feel they its too complicated for the average American to understand? that if it doesn;t fit into a soundbite.. its not worth reporting?

Greenbeard said:

The exchanges have had quite a ride. As recapped in more detail in the The Story of the Exchanges, they launched with premiums well below expectations and remained relatively stable from 2014-16. Then in 2017 there was a correction for initial underpricing, but it turned out to be an overcorrection. But by then Trump was in office and deliberate decisions on the part of his administration artificially drove up premiums for 2018 and will again for 2019 in most places. So instead of the falling premiums we would've seen under a sane administration, we've seen further premium hikes.

Brookings has tried to tease out what should be happening next year in "How Would Individual Market Premiums Change in 2019 in a Stable Policy Environment?"

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Why should we be worried about exchange premiums rising, when people in the exchanges are protected by federal subsidies capping their premium expense?

Neomalthusian said:

Why should we be worried about exchange premiums rising, when people in the exchanges are protected by federal subsidies capping their premium expense?

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Because 1) it’s an unnecessary federal expense, 2) not everyone in the exchanges receives subsidies, and 3) the same actions by the administration drive up all individual market (including non-exchange) premiums.

Greenbeard said:

Because 1) it’s an unnecessary federal expense,

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Unnecessary? Why should we be more worried about the federal share of the premium than the plan members'? In other words, why should we be wanting to limit federal spending on health and maximizing private spending on health? Wasn't the point of Obamacare to put more of the nation's health costs on federal government, rather than less?

2) not everyone in the exchanges receives subsidies

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Well anyone not receiving subsidies because the cost is still less than the threshold at which subsidies kick in is a little hard to feel too badly for, because a lot of other people out there face a lot higher costs for coverage that is not inherently better. Unless you're referring to victims of the subsidy cliff or family glitch that nonetheless still buy from the exchanges, in which case that's another problem that is easily fixed (at least technically speaking).

the same actions by the administration drive up all individual market (including non-exchange) premiums.

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How? Is the sabotage making the cost of health care, or people's collective need for it, greater? Or is it making group market coverage cheaper than it would otherwise be as a sort of tradeoff for individual market increases?

Neomalthusian said:

Unnecessary? Why should we be more worried about the federal share of the premium than the plan members'?

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The premise of your question was why should we care if a particular subset of the population is insulated from Trump’s premium hikes. The answer is that there are other components of this equation, one of which is federal spending (not to mention other populations). That insulation is provided by federal spending that wouldn’t be needed if the markets weren’t being intentionally destabilized.

Unless you're referring to victims of the subsidy cliff or family glitch that nonetheless still buy from the exchanges, in which case that's another problem that is easily fixed (at least technically speaking).

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Yes, I’m speaking of people who don’t get subsides. Was that someone unclear? Again, the premise of your question was “hey, everyone gets subsidies so how can pushing up premiums be bad?”

How?

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By impacting the pricing of insurance products. In this case, artificially driving up the price.

Greenbeard said:

The premise of your question was why should we care if a particular subset of the population is insulated from Trump’s premium hikes. The answer is that there are other components of this equation, one of which is federal spending (not to mention other populations). That insulation is provided by federal spending that wouldn’t be needed if the markets weren’t being intentionally destabilized.

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If premiums for ACA-compliant plans are rising because low risk people are given ways out of buying ACA-compliant plans, then maybe those low risk people who are inclined to opt out were being unduly burdened by this law. This doesn't have to screw anyone over if we would just get rid of the trap doors that were built into this law that arbitrarily disqualify some people from subsidy protection.

Yes, I’m speaking of people who don’t get subsides. Was that someone unclear? Again, the premise of your question was “hey, everyone gets subsidies so how can pushing up premiums be bad?”

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What's unnecessary is that some people are ineligible for subsidies for nonsensical glitchy/arbitrary reasons. Since these are the people you're concerned about (you said "yes"), then it makes less sense to be so worried about premiums rising and why, versus just fixing the glitches that make premium increases extraordinarily more painful for some people than others. If the glitches are fixed and everyone were subsidy-eligible, premiums rising wouldn't put an unreasonable additional cost on any particular insurance buyer.

By impacting the pricing of insurance products. In this case, artificially driving up the price.

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What specifically about Trump's sabotage would explain insurance increasing across the board? "By impacting pricing" does not explain literally what would cause health insurance prices to need to go up across the board.

Neomalthusian said:

What's unnecessary is that some people are ineligible for subsidies for nonsensical glitchy/arbitrary reasons. Since these are the people you're concerned about (you said "yes"), then it makes less sense to be so worried about premiums rising and why, versus just fixing the glitches that make premium increases extraordinarily more painful for some people than others. If the glitches are fixed and everyone were subsidy-eligible, premiums rising wouldn't put an unreasonable additional cost on any particular insurance buyer.

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The rationale behind using insurance markets to try and achieve expanded coverage is based on the assumption that managed care competition will dampen cost growth and make the system more sustainable. Insurers compete directly on premium but can no longer dump risk, the premium they bring to market is based on how well they manage the expenses of their entire population. Instead of the old shell game of risk segmentation, they instead win on premium via aggressive price negotiation with providers, effective population health management and/or alternative payment models with their provider network, and smarter network design. At least in the early going we saw that this approach was effective in holding down provider price growth and in spurring insurers to invest in population health management tools and strategies.

That's how this is supposed to work. Bringing back risk segmentation, screwing up the CSR payment mechanism, removing the individal mandate, teasing a halt to risk adjustment, and all the little daggers the GOP has been using to stab the exchange concept undoes the rationale for using markets and moves the exchanges closer to the GOP's goal of converting them into high risk pools with zero market dynamics.

Trump's deliberate premium hikes don't just make insurance less accessible for the middle class, they signal the coming end of one of the few experiments in pure managed care competition we've ever had (one that looked very promising before they started taking hammers to it).