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Why Massachusetts has the lowest premiums

Greenbeard

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An interesting piece over at the Health Affairs Blog exploring some of the factors that have made the original ACA-style marketplace the cheapest in the country.

Why Massachusetts Stands Out In Marketplace Premium Affordability
Despite operating in a relatively high cost medical state, the Massachusetts Health Connector had the lowest average premiums of any Marketplace in the country for 2017 and 2018. These low premiums benefit not only the quarter million Massachusetts residents enrolled with the Health Connector, but the broader market as well. Massachusetts’s success at keeping Health Connector premiums low is a function of a number of careful state-level policy choices and program design approaches. Exploration of these kinds of tools may be useful to health policy decision-makers in other states, particularly as states take more responsibility for stabilizing and strengthening non-group (individual) insurance markets.
Competition Among Multiple Carriers

[…] Massachusetts has encouraged market competition through a long-standing statutory requirement that carriers with over 5,000 covered lives offer plans through Health Connector. […] All small group and non-group shoppers in Massachusetts can shop through the Health Connector, so a wider range of market participants have the option to benefit from the results of our highly competitive Marketplace than are currently doing so – highlighting an area of untapped opportunity for consumers in our market.

“State Wrap” Rewards And Reinforces Lower Cost Carriers

Though further study is needed, anecdotal evidence indicates that ConnectorCare carriers, who are rewarded for low rates with large shares of enrollment, are able to achieve lower premiums by operating with low administrative margins (in keeping with Massachusetts’s more stringent Medical Loss Ratio [MLR] requirements) and leveraging competitive networks linked to historical experience serving Medicaid populations. […]

Active Purchasing Helps Shoppers Find Lower Cost Plans

Health Connector enrollees tend to pick lower cost plans when given strong decision support and comparison-shopping tools. Like other Marketplaces, the Health Connector has curated a comparison-shopping experience that helps enrollees find lower-cost options. These tools are especially important for unsubsidized shoppers who can currently choose from upwards of 50 plans from 8 carriers (Note 3). In addition, Massachusetts standardizes plans to facilitate apples-to-apples comparisons among carriers, which makes it easier for consumers to evaluate similar options at different price points. […]

Individual Mandate, Merged Market, And Other State Policy Decisions Create A Stable Insurance Framework

In addition to market dynamics specific to the Marketplace, the Health Connector’s low premiums rest on a foundation of strong state insurance regulation that promotes a level playing field. Our 11-year-old state-based individual mandate keeps our risk mix broad and stable. The state’s large pool of insured healthy people (who might otherwise have gone without coverage) likely helps protect our premiums from inflation or volatility. Similarly, our merged market keeps premiums in the non-group market relatively stable by also including small group lives in the same shared risk pool. Other state policy decisions, such as MLR requirements than are required by the ACA, and ongoing investment in tailored outreach to residents in need of coverage, also contribute to low premiums.
 
This could get to be a problem:

State of Massachusetts Debt Clock

Why? What does the debt clock have to do with having competitive markets for healthcare insurance?

How does insurance carriers operating with lower margins, increase the debt clock.

how does active purchasing by consumers increase the debt clock

Please explain.
 
Why? What does the debt clock have to do with having competitive markets for healthcare insurance?

How does insurance carriers operating with lower margins, increase the debt clock.

how does active purchasing by consumers increase the debt clock

Please explain.

The answer is throw anything at the health care wall and hope it sticks.

It’s worth remembering what Republicans said would happen before the A.C.A. went online: that it would fail to reduce the number of uninsured, that it would blow a giant hole in the budget, that it would lead to a “death spiral” of rising premiums and declining enrollment.

What actually happened was a dramatic fall in the uninsured, especially in those states that expanded Medicaid. In early 2014, the Congressional Budget Office projected that under the A.C.A., by 2018 there would be 29 million uninsured U.S. residents. The actual number is 29 million.
 
The answer is throw anything at the health care wall and hope it sticks.

It’s worth remembering what Republicans said would happen before the A.C.A. went online: that it would fail to reduce the number of uninsured, that it would blow a giant hole in the budget, that it would lead to a “death spiral” of rising premiums and declining enrollment.

What actually happened was a dramatic fall in the uninsured, especially in those states that expanded Medicaid. In early 2014, the Congressional Budget Office projected that under the A.C.A., by 2018 there would be 29 million uninsured U.S. residents. The actual number is 29 million.

the most frustrating thing as a conservative and as a republican.. is that the republican party has fought against that free market ideas and the things that work in the ACA... an in some cases systematically weakening them

While maintaining some of the things that don't work well.
 
Meanwhile, statewide Mass just experienced the slowest growth in total health spending in years.

The cost of health care in Massachusetts continues to rise, but at a pace significantly below expectations.

The state Center for Health Information and Analysis (CHIA) finds health care spending grew 1.6 percent from 2016 to 2017, with costs totaling $61.1 billion. That's about $8,900 per resident.
Altman said that 12 years after leading the country in expanding access to health care, Massachusetts is leading the nation in slowing the growth of health care costs. HPC board member Rick Lord agrees.
 
the most frustrating thing as a conservative and as a republican.. is that the republican party has fought against that free market ideas and the things that work in the ACA... an in some cases systematically weakening them

While maintaining some of the things that don't work well.

Ezra Klein‏Verified account @ezraklein




1. Dems adopt Romney's healthcare plan in bid for compromise
2. Republicans spit on the offer and relentlessly sabotage the plan
3. Democrats give up on compromise and embrace Medicare-for-All
4. Republicans: "A-ha! Single-payer was your plan all along!"

(Click on picture for article)




 
Ezra Klein‏Verified account @ezraklein




1. Dems adopt Romney's healthcare plan in bid for compromise
2. Republicans spit on the offer and relentlessly sabotage the plan
3. Democrats give up on compromise and embrace Medicare-for-All
4. Republicans: "A-ha! Single-payer was your plan all along!"

(Click on picture for article)





Funny thing about that.. if Romney had taken the bone that Obama threw him.. when Obama had said.. "well gov.. its like your healthcare proposal"...

If Romney had owned it and said.. yep.. and so here is where you went wrong and where it needs to be changed to work better... He would have owned Obama.. because what could Obama say to that.. he just admitted that Romney was the architect of it.

but instead.. Romney bowed to the whackadoos in the party that thought anger at it would work better..

And lost.. and now we end up with Trump.
 
Tell us Mass citizens here what is considered low. Seems extremely expensive here compared to what I used to pay pre Obama. Tell me what I shoukd be paying and who the ins co is.
 
Tell us Mass citizens here what is considered low. Seems extremely expensive here compared to what I used to pay pre Obama. Tell me what I shoukd be paying and who the ins co is.

CHIA tracks a boatload of statistics on the Massachusetts health care system, including premiums. Premiums here have been quite stable, including relative to the period before the ACA coverage expansions took effect in 2014:

Capture.png
 
CHIA tracks a boatload of statistics on the Massachusetts health care system, including premiums. Premiums here have been quite stable, including relative to the period before the ACA coverage expansions took effect in 2014:

Capture.png

just looking for what people think a family plan costs here in Ma.
 
just looking for what people think a family plan costs here in Ma.

In the exchanges a family premium is just the sum of individual premiums. In Mass the average benchmark premium for a 40-year old this year is ~$316/month. For a child that premium would be ~$170. To get the family premium just add everybody up.
 
In the exchanges a family premium is just the sum of individual premiums. In Mass the average benchmark premium for a 40-year old this year is ~$316/month. For a child that premium would be ~$170. To get the family premium just add everybody up.

what about for those of us who make higher salaries...What is it?
 
what about for those of us who make higher salaries...What is it?

This thread is about the marketplaces. If you're getting insurance through your employer than you're not in a marketplace and your plan is subject to fewer (if any) of the downward cost pressures that plans competing in a real market experience.

Building well-functioning markets is what Massachusetts has done better than other states but it still has the problem that too few people actually buy their insurance through the market.
 
This thread is about the marketplaces. If you're getting insurance through your employer than you're not in a marketplace and your plan is subject to fewer (if any) of the downward cost pressures that plans competing in a real market experience.

Building well-functioning markets is what Massachusetts has done better than other states but it still has the problem that too few people actually buy their insurance through the market.

That didnt answer my question.
 
Meanwhile, statewide Mass just experienced the slowest growth in total health spending in years.

Ok......but the state still sucks with traffic, high costs of consumables, higher costs of home ownership, ****ty drivers, and inconsiderate people. They don't call them Massholes for nothing.

I'll gladly pay a little more for health insurance in another state to avoid living in that ****hole ever again.
 
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